A PhD project is being developed at the Preventive Medicine Institute of the Faculty of Medicine of Lisbon, led by General Practitioner Frederico Rosário Frederico Rosário, and supervised by Professor Cristina Ribeiro of the same Institute, and Professor Niamh Fitzgerald Niamh Fitzgerald of the University of Stirling in Scotland. This project aims to implement early detection and brief interventions for alcohol consumption in healthcare centres and has already been the subject of several publications in national and international journals.

One of these articles – [Rosário F, et al. Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomised controlled trial. Family practice 2018] (epub ahead of print, DOI: 10.1093/fampra/cmy062) [Rosário F, et al. Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial. Family practice 2018] (epub ahead of print, DOI: 10.1093/fampra/cmy062) -, published in June this year, in Family Practice Family Practice, focuses on the protocol of a randomised and controlled trial that was carried out in the Dão Lafões Healthcare Centre Group. The Oxford University Press Journals Oxford University Press Journals group, to which Family Practice Family Practice belongs, considered this article key alcohol search key alcohol research, placing it at the top of a list of articles in the Alcohol: Prevention Alcohol: Prevention. category. This distinction can be found here

Professor Cristina Ribeiro

Coordinator of Integrated Assistance Standards and Processes

Quality Department Physician

Alcohol consumption is an important public health problem and is estimated to be responsible for around 3 million deaths worldwide each year (5.3% of the total) and for about 132.6 million years of life lost due to death or illness (5.1% of the total). Alcohol-related problems are often associated with individuals addicted to this substance. However, most of these problems arise in people affected by high-risk consumption (with no alcohol-related diseases) or harmful consumption (with illness), but who are not addicted.

Primary Health Care is regarded as the ideal context for the early detection of excessive alcohol consumption. A significant percentage of NHS users who go to appointments consume alcohol at high-risk or harmful levels, unaware of the risks associated with the continued intake of this substance. On the other hand, many of the reasons why patients see their GPs are related to alcohol consumption (e.g., dyspepsia, retrosternal burning due to gastro-oesophageal reflux, hypertension, or difficulty in controlling blood pressure, difficulty in controlling glycaemic levels in patients with diabetes, weight gain, among others). Evidence shows that the early detection of excessive alcohol consumption, followed by a brief intervention for high-risk or harmful consumption in Primary Health Care is a highly efficient clinical activity with an excellent cost-benefit ratio.

Despite the evidence in favour of brief interventions, the implementation of these good practices in the clinical routine has proved difficult. A number of barriers to their implementation have been identified, with the most commonly referred ones being lack of time, lack of training, lack of support materials for screening and intervention, or the lack of relevance given to the problems related to alcohol consumption. On the other hand, the programmes aimed at implementing these practices which have been tested so far lack the theoretical support that allows choosing measures to effectively change the clinical practice.

It is with this problem in mind that the PhD project is being developed, aimed at implementing early detection and brief interventions for alcohol consumption in Primary Health Care, having developed an original implementation programme based on theoretical concepts of behaviour change for that purpose. More specifically, the programme was designed following a comprehensive identification of barriers to implementation and their connection to the theoretical content of the Behaviour Change Wheel/Theoretical Domains Framework Behaviour Change Wheel / Theoretical Domains Framework model. This programme, designed with the collaboration of the University of Stirling Stirling(Scotland) and the Catholic Leuven University of Leuven (Belgium), consists of two pillars: training of caregiving teams (General Practitioners, Family Nurses, and Clinical Secretaries); and continued support to clinical practice.

In order to test the effectiveness of this implementation programme, a cluster-randomised controlled trial was designed and tested in 12 functional units (8 Family Health Units and 4 Personalised Health Care Units) of the Dão Lafões Healthcare Centre Group Dão Lafões. The protocol of this study, including the detailed description of the implementation programme based on theoretical foundations, is published in Family Practice Family Practice, , of the Oxford University Press Journals. Oxford University Press Journals group. This journal group considered the article, in which the protocol of the trial is described, as key alcohol research, placing at the top of a list of articles in the Alcohol: Prevention key alcohol research category Alcohol: Prevention.

Frederico Rosário

Coordinator of the Alcohol-Related Problems Pilot Project Team – ACeS Dão Lafões

Doctoral Researcher, Faculty of Medicine of Lisbon