Consum d'alcohol; Persones grans; Disseny de recerca ; Consumo de alcohol; Personas mayores; Diseño de investigación ; Alcohol drinking; Aged; Research design ; Objectives: The European project VINTAGE – Good Health Into Older Age aims at filling the knowledge gap and building capacity on alcohol and the elderly, encouraging evidence- and experience-based interventions. Methods: Systematic review of scientific literature on the impact of alcohol on older people; ad hoc survey and review of grey literature to collect EU examples of good practices for prevention; dissemination of findings to stakeholders involved in the field of alcohol, aging or public health in general. Results: Design and procedures of the VINTAGE project are described, providing also an outline of major results, with particular attention to those related to the dissemination activity. Conclusions: Much more information and research is needed. This issue should be part of both alcohol and healthy ageing policies. ; The VINTAGE project "Good Health into Older Age" is a project funded by the Executive Agency for Health and Consumers, under the European Commission Second Programme of Community Action in the Field of Health 2008-2013 (Grant Agreement no. 20081203).
Alcohol screening; Brief intervention; Referral to electronic brief advice ; Detección de alcohol; Intervención breve; Remisión a asesoramiento breve electrónico ; Detecció d'alcoholèmia; Intervenció breu; Derivació a assessorament breu electrònic ; Objectives: The objective of the present study was toexplore whether the possibility of offering facilitatedaccess to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increasedthe proportion of consulting adults who were screenedand given brief advice. Design: The study was a 12-week implementationstudy. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands,Poland and Sweden) were asked to screen adults whoattended the PHCU for risky drinking. Setting: A total of 120 primary healthcare centresfrom 5 jurisdictions in Europe. Participants: 746 individual providers (generalpractitioners, nurses or other professionals)participated in the study. Primary outcome: Change in the proportion ofpatients screened and referred to eBI comparing abaseline 4-week preimplementation period with a12-week implementation period. Results: The possibility of referring patients to the eBIwas not found to be associated with any increase in theproportion of patients screened. However, it wasassociated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole(p<0.05), mainly driven by a significant increase in briefintervention rates in England from 87% to 96%(p<0.01). The study indicated that staff displayed a lowlevel of engagement in this new technology. Staffcontinued to offer face-to-face advice to a largerproportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among thereferred patients; on average, 18% of the patientslogged on to the website with a mean log-on rate acrossthe different countries between 0.58% and 36.95%. Conclusions: Referral to eBI takes nearly as muchtime as brief oral advice and might require moreintroduction and training before staff are comfortablewith referring to eBI ; The research leading to these results or outcomes has receivedfunding from the European Union's Seventh Framework Programme forResearch, Technological Development and Demonstration under grantagreement no. 259268—Optimizing Delivery of Health Care Interventions(ODHIN).
Consumo de alcohol; Presión sanguínea; Atención primaria; Recomendaciones ; Consum d'alcohol; Pressió sanguínea; Atenció primària; Recomanacions ; Alcohol use; Blood pressure; Primary healthcare; Recommendations ; Background: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. Conclusions: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation. ; The workshop entitled "Screening and intervention for harmful alcohol use as a tool to improve the management of hypertension in primary care", held on November 12, 2015, in Barcelona, Spain, was financially supported by Lundbeck (in providing travel allowances for some participants). An agenda of the workshop can be found in Additional file 1: Appendix 1.
Brief interventions; Risky drinking; Primary healthcare ; Intervenciones breves; Bebedores de riesgo; Atención primaria ; Intervencions breus; Bevedors de risc; Atenció primària ; Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. ; The research leading to these results or outcomes has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 259268 – Optimizing delivery of healthcare intervention (ODHIN).
BACKGROUND: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
