Addressing alcohol dependence in primary care: longitudinal registry-based study of practitioner activity following new policy and access to training.

Abstract

The present study aimed to investigate the extent to which two new implementation strategies-a new policy mandating alcohol interventions in primary care and access to online training, impacted alcohol-related clinical activities in primary care in Stockholm. This was a prospective longitudinal register-based study. One hundred twenty-nine primary care clinics in Region Stockholm agreed to provide data. The new healthcare policy was introduced in February 2021. A brief digital training for primary care professionals on managing harmful alcohol use and dependence was launched 10 months later. Seven indicators that reflect alcohol-related clinical activities were obtained from electronic case files: structured documentation on alcohol habits, the AUDIT instrument, ordering of blood tests for biomarkers of heavy drinking, prescription of medicines for alcohol dependence, registered alcohol-related diagnoses, completed advice regarding alcohol use disorder (AUD), and referrals to specialized care. Data from registers were collected before and after the policy and training was available. At baseline low levels of alcohol-related clinical activities were found in primary care. A modest, clinically non-significant increase was seen for all indicators except for frequency of prescription of medicines for alcohol dependence, over the whole follow-up. The digital training was not associated with an increase in alcohol-related clinical activities. While a policy making alcohol interventions mandatory, combined with a training program, has strong support from implementation science, only a modest, clinically non-significant increase in alcohol-related clinical activities was found. Stronger implementation strategies seem necessary to improve management of alcohol dependence in primary care.