An analysis published in the BMJ authored by Jim McCambridge and Richard Saitz questions the effectiveness of brief advice and counselling in primary care.
According to the article ‘primary care has been promoted for decades as the key setting for delivering brief advice and counselling interventions to reduce heavy alcohol consumption’. However, ‘after three decades of study in primary care it seems unlikely that brief interventions confer any population level benefit, and their ultimate health impact will derive from working in concert with other effective alcohol policy measures’.
The evidence based for brief interventions is inconsistent, with random control trials finding positive results that fail to translate in general practice - More recent NHS general practice trials have shown no benefit. Often the brief interventions that are implemented are very different from those trialed in RCT.
Almost all identified effects from brief interventions are on self-reported alcohol consumption. The authors state that measures are vulnerable to social desirability bias. Also individual risk factors may be reduced without altering health outcomes and little is known about the variability of effects across different segments of the population – differences by age, ethnicity, existence or severity of alcohol problems and brief intervention skills are uneven across health practitioners.
In UK general practice 90% of patients who were identified as consuming too much alcohol also had poor diet, did too little exercise or smoked. The authors argue that it makes little sense to consider screening and other prevention activities for alcohol in isolation from other risky health behaviours or mental health problems. There is a need to think strategically about alcohol within broad based preventions approaches and consider separately how to manage care for those with severe problems.
Upgrading prevention and public health may require structural change in general practice and in other parts of the health system, and this requires a much stronger evidence base than currently exists, the authors state.
Source: Rethinking brief interventions for alcohol in general practice. J McCambridge, R Saitz. BMJ published 19 Jan 2017.