Of 3562 presenting patients, 2991 (84.0%) were eligible for screening; 900 (30.1%) of these patients were identified as hazardous or harmful drinkers. Overall, 756 (84.0%) consented to participate in the trial; consent rates were similar between the three interventions (fig 1). All participants received a patient information leaflet, whereas 99% (n=250) of those allocated to the other two interventions received brief advice. However, just 57% (n=143) of relevant patients returned and received the brief lifestyle counselling intervention.
Fig 1 Flow of participants through trial
At six months the follow-up rates were 85% (patient information leaflet 85% (n=212), brief advice 86% (n=215), and brief lifestyle counselling 85% (n=217)) and at 12 months 82% (patient information leaflet 79% (n=197), brief advice 83% (n=209), brief lifestyle counselling 83% (n=211)). Follow-up rates between the interventions did not differ significantly. However, those followed up at six months had lower mean baseline AUDIT scores than those not followed up: 12.4 (SE 0.25) v 14.3 (SE 0.66).
The average age of participants was 45 years, 62% (n=756) of participants were men, 92% (n=755) were white, 34% (n=253) had attained higher degree level, and 34% (n=258) were smokers (table 1). At baseline 82% (n=611) of participants were identified as hazardous or harmful drinkers by the AUDIT, with an average score of 12.7 (SD 6.4). Reported readiness to change varied across the three interventions, although 62% (n=465) of patients reported never or only sometimes thinking about drinking less.
Table 1 Personal and baseline variables by intervention allocation. Values are numbers (percentages) unless stated otherwise
The proportions of patients with a negative AUDIT status increased at six months in all three interventions (fig 2). The differences between the interventions were not, however, significant (table 2). None of the interactions tested were significant (see supplementary table S1) so the model without interactions was used to estimate the differences between interventions. The odds ratios of having a negative AUDIT status for brief advice compared with the patient information leaflet was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling compared with the patient information leaflet was 0.78 (0.48 to 1.25). The primary outcome was not affected by missing data (table 3).
Fig 2 Proportion of patients scoring <8 (negative status) on alcohol use disorders identification test, representing non-hazardous or non-harmful drinking
Table 2 Proportions of participants with negative alcohol use disorders identification test result at baseline and six and 12 month follow-up. Values are numbers (percentages) unless stated otherwise
Table 3 Summary of sensitivity of primary outcome results to missing data (status from alcohol use disorders identification test at six months)
At 12 months there were no statistically significant differences between the three interventions in the proportions of patients with a negative AUDIT result (table 2). Compared with the patient information leaflet intervention, at 12 months the odds ratio of having a negative AUDIT result was 0.91 (0.53 to 1.56) for brief advice and 0.99 (0.60 to 1.62) for brief lifestyle counselling. A per protocol analysis, including just those who received their allocated treatment, and an analysis combining the more intensive interventions (brief advice plus brief lifestyle counselling versus patient information leaflet) also indicated no significant differences between the interventions at six or 12 months.
In addition, there were no statistically significant differences in mean AUDIT score by intervention or over time (table 4). At six months, the mean difference between brief advice and the patient information leaflet was 0.06 (−0.70 to 0.83) and between brief lifestyle counselling and the patient information leaflet was −0.38 (−1.51 to 0.75). At 12 months these mean differences were larger but not statistically significant. Compared with the patient information leaflet, the mean difference for brief advice was −0.20 (−0.83 to 0.43) and for brief lifestyle counselling was −0.25 (−1.19 to 0.68). The estimates were derived from models without interactions.
Table 4 Alcohol use disorders identification test (AUDIT) scores by condition and over time
At six months there were differences in reported readiness to change (table 5), with 32% (n=65) of patients in the patient information leaflet group reporting “trying to cut down” compared with 34% (n=69) receiving brief advice and 45% (n=93) receiving brief lifestyle counselling. The expected ordered odds for brief lifestyle counselling compared with the patient information leaflet increased by 1.74 (95% confidence interval 1.27 to 2.39, P=0.001) with a shift to the next higher category—that is, a greater readiness to change. For brief advice compared with the patient information leaflet, the expected ordered odds increased by 1.37 (0.95 to 1.98, P=0.095). A similar finding occurred at 12 months, with 32% (n=61) of those in the patient information leaflet group trying to cut down compared with 37% (n=74) receiving brief advice and 48% (n=95) receiving brief lifestyle counselling. For brief lifestyle counselling compared with the patient information leaflet, the expected ordered odds increased by 1.86 (1.31 to 2.65, P=0.001). For brief advice compared with the patient information leaflet, the expected ordered odds increased by 1.24 (0.83 to 1.87, P=0.293).
Table 5 Results for readiness to change by condition and over time. Values are numbers (percentages) unless stated otherwise
Participants who received brief lifestyle counselling also reported greater satisfaction than those who received the patient information leaflet (table 6) based on general communication (mean difference 0.13, 95% confidence interval 0.01 to 0.26) and the interpersonal manner of the clinician delivering the intervention (mean difference 0.10, 0.002 to 0.19). These differences were not observed between brief advice and the patient information leaflet interventions.
Table 6 Patient satisfaction at 12 months
Interaction with earlier screening activity
At six months there was a significant interaction between brief intervention and earlier screening approach, therefore the results are presented as six separate groups (see supplementary table 2). Each group was compared with the reference group of patient information leaflet/universal screening. At the initial follow-up point, patients in the brief lifestyle counselling/universal screening group (mean difference −0.78, 95% confidence interval −1.53 to −0.03) and the patient information leaflet/targeted screening group (mean difference −0.77, −1.42 to −0.12) had significantly lower scores on the alcohol problems questionnaire. But the other four combinations of brief intervention and screening approach did not differ significantly. Furthermore, outcomes measured by the alcohol problems questionnaire at 12 months did not differ significantly (see supplementary table S2).