چکیده (انگلیسی):

Background:Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet
they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and
mechanisms ofwhy, how, for whomandunder what circumstancesimplementation strategies work or do not work
in increasing SBI.
Methods:Semi-structured interviews were conducted betweenFebruary and July 2014 with 40 GPs and 28 nurses in
Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising
Delivery of Healthcare Interventions (ODHIN) trial. This randomisedcontrolledtrialevaluatedtheinfluenceoftrainingand
support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38
providers with a high screening performance and 30 with a low screening performance from different allocation groups.
Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of
implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the
diagram affinity method.
Results:Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision,
sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S
conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as
well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services
rather than a temporary project based payment, might have increased the effects of financial reimbursement.
Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important
preconditions for SBI routine seemed frequent exposure of thistopic in media and guidelines, SBI facilitating information
systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation
strategies have high potential on the micro professional level and meso-organisational level, however due to influences
from the macro- level such as societal and political culture the effects risks to get nullified.
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* Correspondence:myrna.keurhorst@radboudumc.nl
1
Radboud university medical center, Radboud Institute for Health Sciences,
IQ healthcare, Nijmegen, The Netherlands
2
Saxion University of Applied Sciences, Centre for Nursing Research,
Deventer/Enschede, The Netherlands
Full list of author information is available at the end of the article
© 2016 The Author(s).Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keurhorstet al. BMC Family Practice (2016) 17:70
DOI 10.1186/s12875-016-0461-8
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Conclusions:Essential determinants perceived for the implementation of SBI routines were identified, in particular for
training and support and financial reimbursement. However, focusing only onthe primary healthcare setting seems
insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is
requested.
Trial registration:ClinicalTrials.gov. Trial identifier: NCT01501552.