shows the average scores for the measures of knowledge, confidence, perceived obstacles, self-efficacy and expectations before and after the training exercise. Non-physicians had the lowest mean knowledge pre-test score, whereas physicians and medical students scored significantly higher. More importantly, all groups significantly increased in knowledge after receiving the training (F(1, 159) = 320.74, p < .000).
Means (Standard Deviation) of Pre- and Post-Training Scale Scores for Knowledge, Confidence, Perceived Obstacles, Self-Efficacy and Expectations by Training Group
Compared to physicians and medical students, non-physicians reported less confidence in screening patients prior to training. After training an interaction effect was found indicating that the level of confidence gain was dependent on group membership (F(2, 172) = 4.21, p = .016). Post hoc comparisons indicated that physicians and medical students reported significantly increased confidence in implementing screening procedures in comparison to non-physicians, who indicated about the same level of confidence after training as they did at baseline.
Physicians had significantly more confidence in their ability to conduct brief interventions than non-physicians and medical students prior to training. An interaction effect was observed between group membership and confidence in conducting brief interventions (F(2, 170) = 9.97, p < .000). Post hoc comparisons indicated that medical students gained significantly more confidence in their ability to perform brief interventions than did the other groups. Interestingly, physicians did not increase their confidence in conducting brief interventions after training.
The remaining measures listed in pertain only to the physicians and non-physicians. Medical students were not given these items because they were not expected to practice SBI as the MCO personnel were. At baseline, physicians perceived significantly fewer obstacles to screening patients than non-physicians. After training, an interaction was observed involving group membership (F(1, 90) = 5.59, p = .02). Physicians remained basically the same in their perceptions of obstacles to screening, whereas non-physicians reported significantly fewer concerns than they had endorsed prior to training.
Regarding brief interventions, at baseline physicians perceived fewer obstacles than did non-physicians. After training, both physicians and non-physicians perceived significantly fewer barriers to helping patients (F(1, 90) = 20.18, p < .000).
Before training, physicians indicated higher self-efficacy in implementing SBI than non-physicians. At follow-up, both physicians and non-physicians increased in self-efficacy (F(1, 89) = 40.34, p < .000).
Prior to training, physicians reported significantly higher expectations for the benefits of brief interventions than did non-physicians. After training, both physician and non-physician providers raised their level of expectations significantly relative to their respective baseline scores (F(1, 91) = 57.19, p < .000).
Changes in knowledge, confidence, self-efficacy and perceived obstacles are important objectives of any training program, but the ultimate goal is to change provider behavior. In the ten clinics where training was conducted, and at the five comparison clinics where no training was offered, a sample of patients who screened positive for at-risk drinking on the Alcohol Use Disorders Identification Test was contacted three months after their office visit to determine whether they had received an intervention. The results indicated that only 21.9% of the comparison clinic patients reported that their provider talked to them about their drinking. In contrast, 47% of patients who screened positive in the clinics in which physicians were trained to conduct interventions reported that their doctor talked with them about alcohol use (χ21 = 65.13, p < .000). Similarly, whereas only 3% of patients in the comparison clinics reported that their doctor gave them printed materials, 42.4% of patients in the provider trained clinics remembered receiving printed materials (χ21 = 219.54, p < .000).
summarizes the findings from provider questionnaires completed at the end of the program implementation period in both the trained intervention and untrained control clinics. Providers were asked the same questions about how often they used standard alcohol screening tests and how many patients they managed for drinking during the past year. Providers in the intervention clinics reported significantly more screening and patients managed for drinking than their counterparts in the control clinics who were not trained.
Screening and Brief Intervention Activities Reported by Physicians and Non-Physicians in Control and Intervention Clinics During the Cutting Back® Implementation