Prevention of alcohol problems in primary care: a novel approach combining policy and training in the 15 method

The aim of this project is to study the effects of a combination of sticks, carrots and sermons(using the terminology of Evert Vedung) in the implementation of alcohol prevention inprimary healthcare.Excessive alcohol consumption is a significant risk factor for several major health problems.Early detection and treatment can have an important impact on reducing the health burden ofhigh alcohol intake, but studies in several countries have documented low levels ofimplementation in primary care.An important reason why implementation of screening and brief intervention programs hasfailed is the reluctance among practitioners to raise questions within a field where they lackcompetence.

By providing practitioners with simple but effective tools to treat alcoholdependence they will be more competent and ready to raise alcohol questions.The 15 method, developed by our group, is specifically designed to overcome theselimitations and increase the effectiveness of alcohol prevention in primary care.

It is astepped-care program, including brief intervention, assessment and psychological andpharmacological treatment.A new policy initiative is now in force in the Stockholm Region, where the management ofalcohol use disorders is mandated in new health care agreements with all primary health careclinics (200+ clinics) in the region.In a prospective longitudinal study we will evaluate the effects of requirements and trainingseparately and in combination.

We will study changes in key alcohol related activitiesperformed by the staff at five time points, before and efter the policy shift.

Data for theseanalyses will be extracted from the central electronic case files system.The shift in policy (sticks and carrots), in combination with a training program in the 15-method (Sermons), provides a unique opportunity to study the impact of requirements andtraining on primary care management of alcohol related problems.