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NAT 6/08 - THL

NAT 6/08 - THL

Brief intervention,

Brief intervention, three decades on new skills and more emphasis on enabling health professionals to build on skills they already have and use in practice. Factors such as time restrictions and inadequate reimbursement for alcoholpreventive work may be less amenable to short-term change. Studies on the impact of economic incentives on health professionals’ preventive care delivery have suggested that small rewards will not motivate physicians to change their routines (Town et al. 2005). However, pay-for-performance incentives have shown to be effective in increasing the delivery of smoking cessation advice given by primary health care physicians (Millett et al. 2007). Unquestionably, financial incentives affect behaviour and instead of asking “can financial incentives result in more preventive activity?” it may be more relevant to inquire “how large an incentive does it take to change behaviour?”. Health care professionals generally face time barriers to providing preventive services because most health care systems are focused on the management of acute illness and chronic health conditions (Glasgow et al. 2004). Still, the question is whether lack of time for alcohol-preventive work should be taken at face value. As pointed out by Aira et al. (2003), “Why do we not have any barriers to examining diabetic patients or to follow-up of high blood pressure, even if it takes a lot of time?” It would appear that priorities for screening particular illness conditions are based on health professionals’ knowledge, existence of tools, and their perceptions of patient requests. The use of computer-generated BI offers a potential means of minimising time restraints. There is a growing body of evi- 462 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 dence supporting the effectiveness of computer-generated advice for many health behaviours, including drinking, smoking, diet, obesity, and physical activity (Nilsen et al. 2008). Computerized concepts have also been favourably evaluated in terms of feasibility, including health care providers’ acceptability of such approaches and patients’ willingness to participate in and satisfaction with computer-based interventions (MacMillan 1999; Rhodes et al. 2001; Gregor et al. 2003; Karlsson et al. 2005; Bendtsen et al. 2007). Although research on BI has accumulated rapidly during the last three decades, important research challenges and development work remain before BI is widely implemented in routine health care and is considered an integral part of mainstream preventive medicine and public health. However, the future of BI will depend not only on the available science base; more research alone will not be sufficient. Researchers have been the main agents of change in the move toward viewing alcohol risk in terms of a continuum and applying a population approach. However, it is important to recognize that the general public does not necessarily view alcohol problems and their solutions this way, which influences the feasibility and acceptability of providing BI in routine health care. Ultimately, a broad, all-encompassing systems approach involving not just researchers but also government agencies, health policy-makers, health care organisations, consumers, and the media is needed to build wider support for BI through increased public awareness of recommended drinking levels and modified public attitudes towards alcohol problems and alcohol-preventive work that focus on

larger proportions of the population. To the extent that integrated screening and BI activities can become part of a broader public health approach to alcohol-related problems, they have the potential to make a significant contribution to the reduction of alcohol-related harm at the level of both individuals and populations. REFERENCES Aalto, M. & Pekuri, P. & Seppä, K. (2001): Primary health care nurses’ and physicians’ attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers. Addiction 96: 305–311 Aalto, M. & Pekuri, P. & Seppä, K. (2002): Primary health care professionals’ activity in intervening in patients’ alcohol drinking: a patient perspective. Drug and Alcohol Dependence 66: 39–43 Adair, J.G. (1984): The Hawthorne Effect: A Reconsideration of the Methodological Artefact. Journal of Applied Psychology 69: 334–345 Aira, M. & Kauhanen, J. & Larivaara, P. & Rautio, P. (2003): Factors influencing inquiry about patients’ alcohol consumption by primary health care physicians: qualitative semi-structured interview study. Family Practice 20 (3): 270–275 Anderson, P. (1985): Managing alcohol problems in general practice. British Medical Journal 290: 1873–1876 Anderson, P. & Kaner, E. & Wutzke, S. & Wensing, M. & Grol, R. & Heather, N. & Saunders, J. (2003): Attitudes and mana- Brief intervention, three decades on Per Nilsen M.d., Phd, associate Professor dep. of social Medicine and Public health lindköping university, sweden e-mail: per.nilsen@liu.se Eileen Kaner Phd, Prof. inst. of health & society, newcastle university, uK e-mail: e.F.s.Kaner@ncl.ac.uk Thomas F. Babor Phd, M.P.h. dep. of community Medicine and health care university of connecticut health center, Farmington, connecticut, usa e-mail: babor@nso.uchc.edu gement of alcohol problems in general practice: Descriptive analysis based on findings of a World Health Organization international collaborative study. Alcohol and Alcoholism 38 (6): 597–601 Anderson, P. & Laurant, M. & Kaner, E. & Wensing, M. & Grol, R. (2004): Engaging General Practitioners in the Management of Hazardous and Harmful Alcohol Consumption: Results of a Meta-Analysis. Journal of Studies on Alcohol and Drugs 65: 191–199 Ashenden, R. & Silagy, C. & Weller, D. (1997): A systematic review of the effectiveness of promoting lifestyle change in general practice. Family Practice 14 (2): 160–176 Babor, T.F. & Higgins-Biddle, J.C. (2000): Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction 95 (5): 677–686 Babor, T.F. & Higgins-Biddle, J. & Dauser, D. & Higgins, P. & Burleson, J.A. (2005): Alcohol Screening and Brief Intervention in Primary Care Settings: Implementation Models and Predictors. Journal of Studies on Alcohol and Drugs 66 (3): 361–368 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 463

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