This study examines the impact of marketing strategies on the dissemination of a brief alcohol intervention program to general practitioners (GPs). The marketing strategy was tested to determine the ...most effective way to promote awareness about and consideration of a brief alcohol intervention program. The study also examines the impact of training and support strategies to promote the program's implementation in routine primary care.
A pragmatic trial was carried out in Australia, Belgium (Flanders), Denmark, England, New Zealand and Spain (Catalonia) in which GPs were randomly allocated into one of three marketing conditions (direct mail, telemarketing and academic detailing personal visits). The GPs who requested a brief intervention program and agreed to use it were stratified by previous marketing condition and randomly allocated into one of three implementation strategy groups: written guidance, outreach training and outreach training plus ongoing telephone support.
Acceptance of the brief intervention program was more effective with use of telemarketing (65%) and academic detailing (67%) than with direct mail (32%) for promoting awareness about and consideration of a brief alcohol intervention program. The median proportion of patients screened was higher for trained GPs (6%) and supported GPs (9%) than for control GPs (1%), who received only written guidance on how to conduct brief intervention. Similarly, the median rate for giving advice to at-risk patients was higher for trained GPs (3%) and supported GPs (3%) than for control GPs (0%).
The adoption of more direct approaches for disseminating evidence-based intervention programs to GPs is a necessary first step for changing practice behavior. However, outreach training was required to promote actual use of a new procedure in routine practice.
We developed an electronic patient-facing family history collection tool including B-RST 3.0, PREMM5 risk assessments and “limited family knowledge/structure” information designed for primary care ...settings. We evaluated the tool’s performance compared with genetic-counselor-collected information for clinical risk stratification in a population with barriers to access.
English- or Spanish-speaking patients aged 18 to 49 were invited to participate. Individuals with limited family knowledge or at high or moderate risk based on their responses in the tool were offered genetic testing and counseling. We assessed overall agreement of family history collected in the tool compared with family history collected by the genetic counselors using Krippendorff’s alpha (K-alpha). Multivariable logistic regression was used to assess characteristics associated with inaccuracy.
Most people (94%, n = 1711) who interacted with the tool completed it. Those included in the agreement analysis (n = 604) had a median age of 36.3 years, 81.6% were female, and 44.4% were Non-Hispanic White. Both the B-RST 3.0 and PREMM5 had moderate agreement: 69.9% (K-alpha = .40, 95% CI 0.32, 0.47) and 83.9% (K-alpha = .52, 95% CI 0.43, 0.60), respectively. Agreement was high (96%) for people with clinically significant risk for 1 of the hereditary cancer syndromes. For B-RST 3.0, the factors significantly associated with inaccuracy were study site, sex, and race/ethnicity. For PREMM5, age, sex, and education were associated with inaccuracy. Barriers to access were not associated with inaccuracy.
Implementation of this tool could increase identification of individuals at risk for hereditary cancer syndromes, including those with barriers to health care access.
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