More detailed interventions for harmful drinking offer no advantage over simple feedback and written information, an English general practice study has found.

Of 3,562 patients routinely presenting in 24 practices who were eligible for the study, 900 (30.1%) screened positive for hazardous and harmful drinking. Of these, 756 consented to enter the study and received an immediate intervention within the same consultation.

Each participating practice was allocated randomly to deliver one of three specific interventions either:

• A patient information leaflet: brief feedback on the screening result plus a leaflet detailing the consequences of heavy drinking and web-based, telephone and local resources to help with alcohol use or

• Brief advice: both of the above together with five minutes of one-to-one structured brief advice or

• Brief lifestyle counselling: all of the above together with an appointment for a 20 minute follow-up consultation within two weeks for motivational based counselling.

Because of the extensive evidence supporting the effectiveness of brief interventions in this area, a no intervention arm was not included.

Researchers, who were blinded to the allocated intervention, contacted study participants at six and 12 months after randomisation for follow-up information, and alcohol screening, and also after 12 months for completion of a satisfaction questionnaire. Follow-up rates were 83% at 6 months and 79% at 12 months. The proportion of patients with a negative alcohol screening status at six months increased following all three interventions from 20% to 36% in the patient information group, from 20% to 29% in the brief advice group and from 15% to 29% in the brief lifestyle counselling group but the differences in outcome were not statistically significant between the interventions. The odds ratio (OR) of having a negative screening status for brief advice compared with the patient information leaflet was 0.85 (95% CI: 0.52-1.39) and for brief lifestyle counselling compared with the patient leaflet 0.78 (95% CI: 0.48-1.25).

At 12 months there was no significant difference in outcomes between the interventions; negative alcohol screening rates were 39%, 35% and 36% respectively in the three groups. The OR of having a negative screening status for brief advice compared with the patient information leaflet was 0.91 (95% CI: 0.53-1.56) and for brief lifestyle counselling compared with the patient information leaflet 0.99 (95% CI: 0.60-1.62).

Participants who received brief lifestyle counselling reported greater satisfaction than those who received the information leaflet intervention, but only 57% of participants allocated to brief lifestyle counselling actually returned and received the counselling intervention.

The authors conclude that the high level of consent for the trial (84%) and satisfaction measures indicate a willingness for routinely presenting patients in primary care to receive advice about their drinking behaviour. The high rate of non-attendance for a subsequent appointment was noted, signifying the need to deliver brief interventions without delay following screening.

Overall, longer and more intensive interventions added no significant additional benefit over a brief intervention of feedback plus an information leaflet, and the authors suggest this is the most appropriate strategy in primary care.

Dr Jez Thompson

• Kaner E, Bland M, Cassidy P et al. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial); pragmatic cluster randomised controlled trial. BMJ 2013;346:e8501