Drinking-related health problems are more frequent in Latin America compared to other regions in the world. One way to tackle this is through primary healthcare – doctors and nurses –, the entry point to health systems around the world. The EU-funded SCALA project implemented a new evidence-based training approach, aiming to scale up the prevention of alcohol-related disorders in the region. SCALA worked with primary healthcare units in Colombia, Mexico and Peru, training local responders to identify alcohol use disorders and comorbid depression and dispense advice. “Given that heavy drinking and feelings of depression often go hand-in-hand, we also wanted to establish if we could get primary healthcare providers to assess a higher number of heavy drinking patients for depression,” says Peter Anderson, a public health specialist at Maastricht University. “We sought to change the behaviour of providers by offering them short and simple training, and by delivering local community support and communication campaigns,” he explains. Training increased the number of heavy drinking patients assessed for depression, adding to evidence this is an effective strategy. And calculations showed that the cost per person whose alcohol consumption was measured was USD 3, leading to savings from a later alcohol-related hospital admission of USD 5.40 per patient. “We showed that by ensuring that at least one quarter of the population were asked about their drinking, this would reduce societal levels of alcohol consumption,” adds Anderson. “The findings are transferable to primary healthcare activity in all countries of the world, not just the Latin American middle-income countries that we analysed.”
Training healthcare providers and running trials
Primary healthcare centres were randomly assigned to one of four groups. The control group had no training. One group received a couple of hours of basic training, learning how to assess and advise on alcohol use in 2-3 minutes, and how to assess depression. The third group had slightly more training, where all assessments and advice could be delivered in 2-3 minutes. This was backed up by community support and communication campaigns on the benefits of drinking less. The final group received yet more intensive training, learning to deliver a lengthy assessment and advice package in 5 minutes. This also included community support. The trials showed both training and community support led to more patients having their alcohol consumption assessed. For each patient asked about alcohol in the control, there were 13 asked in the training-only group and 17 in the training with community support groups.
Strong results despite pandemic disruptions
Unfortunately, the COVID pandemic interfered with the community support package, and the team believes the impact of this aspect could have been even greater in other circumstances. “Despite COVID, and due to the hard work of the Latin American implementers, we managed to keep the project going, with demonstrable results. We achieved strong working relationships across countries, cultures, professional backgrounds and time zones,” says Anderson. SCALA’s results could be replicated in primary healthcare systems around the world, and are transferable to other behavioural risk factors, including smoking, unhealthy diet and low physical activity. All the materials used in the project are freely available in English and Spanish on the project website.
SCALA, alcohol, heavy, drinking, comorbid, depression, primary, healthcare