Motiposh: brief intervention in primary care for patients with problematic use of alcohol

Background and relevance

Of the nearly 2 million problematic alcohol users, many are already regularly seen by a medical professional. Every visit to a medical professional in the Netherlands could be an opportunity for screening and intervening. This is recognized in the United Kingdom with the “Make every Consult count (MECC)” approach but also in the United States, where the National Institutes of Health (NIH) conceived of the Screening- Brief Intervention- Referral to Treatment (SBIRT). This last intervention was developed to be used in primary care settings, such as the emergency department or the consultation room of General practitioners (GPs) or Addiction Physicians. In the Netherlands MOTI4 and MOTI55 have been developed as conversational interventions that have been recognized by Dutch health authorities as successful interventions for problematic use of alcohol. A recent report from Dutch institute Nivel on most frequent health problems in a GP consultation suggest there is ample opportunity if not reason for an intervention in problematic alcohol users: hypertension, depression and anxiety are top 10 complaints. Knowing that lifestyle and/or alcohol interventions are necessary is not enough , there are a number of barriers to implement such a intervention. These barriers have been researched in the past years. Even when these issues are resolved, the matter of the right tool remains. MECC uses the 5As conversation as a very brief intervention (VBI).There is a simpler 3A-version currently in implementation in the United Kingdom, using Ask: screen for alcohol use, Assist: provide motivational health information and Act: refer for a follow up intervention or treatment). This version is implemented in the Netherlands as a smoking cessation interventio. The Very Brief Advice plus (VBA+), supported by the Trimbos institute in the Netherlands, is a version with a warm referral to a follow-up conversation with a mental health professional or treatment. The VBA+ has been implemented in several GP practices for smoking cessation, but not yet for problematic alcohol use.

Plan of approach

This research project entails an intervention-based study aimed at developing a conversational brief intervention targeting patients exhibiting problematic alcohol use, which may contribute to somatic and/or psychiatric complaints. The intervention aligns with contemporary approaches in motivational interviewing and positive health. Grounded in a pragmatist philosophy, the research design employs a mixed-method approach, encompassing both qualitative and quantitative methodologies.

Short description of general research approach

The proposed research contains 6 work packages (WP1-6): 

• During the first year of our project, we will organize all other necessary preparations for WP4 (i.e. METC, organizing information sessions or workshops, compiling an e-learning, and recruitment of participating GP and Addiction Physicians). 
• In WP1 (M1-6) we will perform a scoping review. 
• In WP2 (M3-9) we will explore barriers to implementation.
• In WP3 (M13-15) we will design the intervention, using insights from WP1 and WP2, using the Consolidated Framework for Implementation Research (CFIR) for testing the VBA+ version. 
• In WP4 (M 16-18) we will perform a feasibility study. 
• In WP5 (M24-30) we will explore the effect of the intervention on physician competence and lessons. 
• In WP6 (M36-42) we will invite data from GP’s who participated in the training by using code P15/ Z72, the code for the intervention, and data on patients.