Primary Care-based Facilitated Access to a Web Based Brief Intervention to Reduce Alcohol Consumption

Trial design: A randomised non-inferiority controlled trial in primary care comparing facilitated access to a website for risky drinkers against a standard face-to-face BI. With the exception of the non-experimental intervention, all components of the study will be administered online to patients. Patients will be actively encouraged by their PHCP to access the application, which is available on the website of the programme 'Alcohol y Salud' (http:// www.alcoholysalud.cat), and will be provided with a unique registration code. The trial website is a Spanish adaptation of the English version of http://www.DownYourDrink.org.uk (DYD) developed in the UK, which includes modules for all the key trial components including screening, consent, assessment, randomisation and follow-up. It also incorporates the alcohol reduction website for the patients in the experimental group. The site has been adapted from the http://www.DownYourDrink.org.uk website developed for the DYD-RCT (randomised controlled trial).14 Details of DYD and the psychological theory that underpinned its development have been reported elsewhere. 21 Country-specific information such as recommended guidelines for alcohol intake, definitions of standard drinks and alcohol-related laws will be included. The website also incorporates a menu-driven facility to enable PHCP to customise automated messages to patients, for example, by adding photographs and pre-recorded messages. The personalised messages will appear to each patient using the log-in code provided by that practitioner.

Practitioner recruitment, training and incentives:

Recruitment will be based on the XaROH network. A 3 h seminar on new technologies, and EI and BI, introducing the trial, will be offered to all members of the XaROH, and those attending will be invited to sign up for the trial. In addition, several advertisements will be posted on the 'Beveu Menys' platform offering participation in the trial. In selecting practices, preference will be given to those with at least 5000 registered patients. Those practices that are selected as participants will be required to undergo a 1-day training programme. The training has four steps: (1) introduction to trial; (2) familiarisation with website; (3) update about EI and BI; and (4) practice in EI and BI (role-playing). Finally, participants will be encouraged to use the website and to tailor-make patient messages. Participating PHCPs will receive a financial incentive of €20 per patient recruited to the trial.

Inclusion criteria

• Patients aged 18 years old or over attended in primary care during the study period
• AUDIT-C 4 or above for women and 5 or above for men (in online screening)

Exclusion criteria

• Severe psychiatric disorders
• Serious visual impairment
• Terminal illness
• To have inadequate command of the Spanish or Catalan language
• AUDIT ≥ 18 in baseline assessment.

Excluded patients will be referred to GPs to consider other interventions.