{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:13:27Z","timestamp":1787609607418,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":51,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Research Council for Health, Working-Life and Welfare","award":["2021-01706"],"award-info":[{"award-number":["2021-01706"]}]},{"name":"Systembolaget Research Council for Alcohol Research","award":["2020-0032"],"award-info":[{"award-number":["2020-0032"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The present study aimed to investigate the extent to which two new implementation strategies\u2014a new policy mandating alcohol interventions in primary care and access to online training, impacted alcohol-related clinical activities in primary care in Stockholm. This was a prospective longitudinal register-based study. One hundred twenty-nine primary care clinics in Region Stockholm agreed to provide data. The new healthcare policy was introduced in February 2021. A brief digital training for primary care professionals on managing harmful alcohol use and dependence was launched 10 months later. Seven indicators that reflect alcohol-related clinical activities were obtained from electronic case files: structured documentation on alcohol habits, the AUDIT instrument, ordering of blood tests for biomarkers of heavy drinking, prescription of medicines for alcohol dependence, registered alcohol-related diagnoses, completed advice regarding alcohol use disorder (AUD), and referrals to specialized care. Data from registers were collected before and after the policy and training was available. At baseline low levels of alcohol-related clinical activities were found in primary care. A modest, clinically non-significant increase was seen for all indicators except for frequency of prescription of medicines for alcohol dependence, over the whole follow-up. The digital training was not associated with an increase in alcohol-related clinical activities. While a policy making alcohol interventions mandatory, combined with a training program, has strong support from implementation science, only a modest, clinically non-significant increase in alcohol-related clinical activities was found. Stronger implementation strategies seem necessary to improve management of alcohol dependence in primary care.<\/jats:p>","DOI":"10.1093\/eurpub\/ckaf060","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T13:17:08Z","timestamp":1749561428000},"page":"720-725","source":"Crossref","is-referenced-by-count":1,"title":["Addressing alcohol dependence in primary care: longitudinal registry-based study of practitioner activity following new policy and access to training"],"prefix":"10.1093","volume":"35","author":[{"given":"Karin","family":"Hyland","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet , Stockholm,","place":["Sweden"]},{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services , Stockholm,","place":["Sweden"]},{"name":"Stockholm Centre for Dependency Disorders, Stockholm Health Care Services , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Hammarberg","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services , Stockholm,","place":["Sweden"]},{"name":"Stockholm Centre for Dependency Disorders, Stockholm Health Care Services , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Hedman-Lagerl\u00f6f","sequence":"additional","affiliation":[{"name":"Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm,","place":["Sweden"]},{"name":"Gustavsberg University Primary Care Center, Stockholm Health Care Services , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olle","family":"Wiklund","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingvar","family":"Rosendahl","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Andreasson","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services , Stockholm,","place":["Sweden"]},{"name":"Stockholm Centre for Dependency Disorders, Stockholm Health Care Services , Stockholm,","place":["Sweden"]},{"name":"Department of Global Public Health, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Nilsen","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Linkoping,","place":["Sweden"]},{"name":"School of Health and Welfare, Halmstad University , Halmstad,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"2025073115065214000_ckaf060-B1","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/alcalc\/agx126","article-title":"Treatment for alcohol dependence in primary care compared to outpatient specialist treatment\u2014a randomized controlled trial","volume":"53","author":"Wallhed Finn","year":"2018","journal-title":"Alcohol Alcohol"},{"key":"2025073115065214000_ckaf060-B2","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/YCO.0000000000000435","article-title":"Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update","volume":"31","author":"Segura","year":"2018","journal-title":"Curr Opin Psychiatry"},{"key":"2025073115065214000_ckaf060-B3","first-page":"CD004148","article-title":"Effectiveness of brief alcohol interventions in primary care populations","volume":"2","author":"Kaner","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025073115065214000_ckaf060-B4","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1093\/alcalc\/agu043","article-title":"Managing alcohol problems in general practice in europe: results from the European ODHIN Survey of General Practitioners","volume":"49","author":"Anderson","year":"2014","journal-title":"Alcohol Alcohol (Oxford)"},{"key":"2025073115065214000_ckaf060-B5","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1093\/alcalc\/agh185","article-title":"Attitudes of swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption","volume":"40","author":"Geirsson","year":"2005","journal-title":"Alcohol Alcohol (Oxford)"},{"key":"2025073115065214000_ckaf060-B6","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/s11920-011-0219-x","article-title":"New developments in brief interventions to treat problem drinking in nonspecialty health care settings","volume":"13","author":"Wilson","year":"2011","journal-title":"Curr Psychiatry Rep"},{"key":"2025073115065214000_ckaf060-B7","author":"The 15-Method: 15-metoden, manual fo\u0308r prima\u0308rva\u030ard","year":"2021"},{"key":"2025073115065214000_ckaf060-B8","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3109\/02813432.2012.679229","article-title":"General practitioners\u2019 strategies to identify alcohol problems: a focus group study","volume":"30","author":"Lid","year":"2012","journal-title":"Scand J Prim Health Care"},{"key":"2025073115065214000_ckaf060-B9","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jsat.2004.12.002","article-title":"The Drinker\u2019s Check-up: 12-month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers","volume":"28","author":"Hester","year":"2005","journal-title":"J Subst Abuse Treat"},{"key":"2025073115065214000_ckaf060-B10","author":"Babor","year":"2001"},{"key":"2025073115065214000_ckaf060-B11","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1111\/j.1360-0443.2009.02848.x","article-title":"Brief alcohol intervention: time for translational research","volume":"105","author":"Kaner","year":"2010","journal-title":"Addiction (Abingdon, England)"},{"key":"2025073115065214000_ckaf060-B12","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1111\/j.1465-3362.2010.00236.x","article-title":"NICE work if you can get it: development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England","volume":"29","author":"Kaner","year":"2010","journal-title":"Drug Alcohol Rev"},{"key":"2025073115065214000_ckaf060-B13","volume-title":"WHO Alcohol Brief Intervention Training Manual for Primary Care","author":"Fitzgerald","year":"2017"},{"key":"2025073115065214000_ckaf060-B14","doi-asserted-by":"crossref","first-page":"3609","DOI":"10.3390\/ijerph8093609","article-title":"Implementing brief interventions in health care: lessons learned from the Swedish Risk Drinking Project","volume":"8","author":"Nilsen","year":"2011","journal-title":"Int J Environ Res Public Health"},{"key":"2025073115065214000_ckaf060-B15","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/add.13675","article-title":"Screening, brief intervention and referral to treatment: implications of SAMHSA\u2019s SBIRT initiative for substance abuse policy and practice","volume":"112","author":"Babor","year":"2017","journal-title":"Addiction (Abingdon, England)"},{"key":"2025073115065214000_ckaf060-B16","author":"Care Need Index (CNI), Statistics Sweden"},{"key":"2025073115065214000_ckaf060-B17","doi-asserted-by":"publisher","DOI":"10.4324\/9780203852279","volume-title":"Multilevel Analysis: Techniques and Applications","author":"Hox","year":"2010","edition":"2nd edn"},{"key":"2025073115065214000_ckaf060-B18","author":"R Core Team","year":"2023"},{"key":"2025073115065214000_ckaf060-B19","doi-asserted-by":"crossref","first-page":"e104012","DOI":"10.1371\/journal.pone.0104012","article-title":"Nonlinear mixed-effects (NLME) diameter growth models for individual China-Fir (Cunninghamia lanceolata) trees in Southeast China","volume":"9","author":"Xu","year":"2014","journal-title":"PloS One"},{"key":"2025073115065214000_ckaf060-B20","author":"National Board of Health and Welfare","year":"2021"},{"key":"2025073115065214000_ckaf060-B21","author":"Centrum f\u00f6r Epidemiologi och Samh\u00e4llsmedicin, Folkh\u00e4lsorapport","year":"2023"},{"key":"2025073115065214000_ckaf060-B22","first-page":"1423","article-title":"No magic bullets: a systematic review of 102 trials of interventions to improve professional practice","volume":"153","author":"Oxman","year":"1995","journal-title":"CMAJ"},{"key":"2025073115065214000_ckaf060-B23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3389\/fpubh.2019.00003","article-title":"Enhancing the impact of implementation strategies in healthcare: a research agenda","volume":"7","author":"Powell","year":"2019","journal-title":"Front Public Health"},{"key":"2025073115065214000_ckaf060-B24","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1001\/jama.2007.26","article-title":"The meaning of translational research and why it matters","volume":"299","author":"Woolf","year":"2008","journal-title":"JAMA"},{"key":"2025073115065214000_ckaf060-B25","author":"Region Stockholm","year":"2023"},{"key":"2025073115065214000_ckaf060-B26","doi-asserted-by":"publisher","first-page":"795144","DOI":"10.3389\/frhs.2021.795144","article-title":"Conceptualising four categories of behaviours: implications for implementation strategies to achieve behaviour change","volume":"1","author":"Nilsen","year":"2021","journal-title":"Front Health Serv [online]"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/35\/4\/720\/63464227\/ckaf060.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/35\/4\/720\/63464227\/ckaf060.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T19:07:07Z","timestamp":1753988827000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/35\/4\/720\/8159905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,10]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,6,10]]},"published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckaf060","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,6,10]]}}}