■ INTRODUCTION
Alcohol overconsumption remains a major global public health concern. According to the World Health Organization (WHO), excessive drinking contributes to a range of health issues, including liver disease, cardiovascular conditions, cancer and mental disorders [1, 2]. It is also linked to higher rates of injuries, traffic accidents and economic costs [3].
In Europe, alcohol use drives socioeconomic inequalities and mortality [4], with binge drinking increasingly affecting younger populations and women [5]. The broader societal costs include healthcare expenses, productivity loss, and social harm like crime and homelessness [6, 7]. Czechia ranks among the countries with the highest alcohol consumption rates globally. According to the Czech National Institute of Public Health [8], 8.3% of the population engaged in hazardous drinking and 6.3% in harmful drinking in 2023. Similarly, Mravčík et al. [9] reported high-risk drinking in 16.8-17.6% and harmful use in 9.0-9.3% of adults in 2019.
Brief interventions in alcohol
Brief interventions (BI) are short, structured counselling strategies aimed at reducing risky alcohol use through motivational techniques. They are often delivered as part of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has proven effective in minimising alcohol-related harm [10]. A growing body of research supports their impact on reducing alcohol consumption and associated risk. For instance, O’Connor et al. [11] confirmed that BI significantly reduce alcohol use among risky drinkers, while Kaner et al. [12] found consistent though moderate effects in primary care settings.
BI delivered digitally – via mobile or web-based platforms – have also shown efficacy, especially for younger individuals or those avoiding in-person care [13]. In emergency departments, BI can reduce alcohol-related injuries and admissions [14]. School-based BI programmes, as shown by Carney et al. [15], lower alcohol use among adolescents, highlighting the value of early prevention. Finally, digital tools like text messaging and online resources can help sustain behaviour change over time [16].
Barriers to BI adoption
Despite strong evidence for BI effectiveness, their routine use in clinical practice remains limited.
Many healthcare professionals do not consistently implement BI, even when patients are identified as at-risk [17]. In the Czech Republic, less than half of GPs use BI regularly, and nearly a quarter rarely or never [9].
Common barriers include lack of training, time pressure and competing clinical demands [18, 19]. BI is often perceived as an additional burden rather than a standard part of care. System-level issues like inadequate reimbursement and limited digital integration also hinder implementation [20]. Key obstacles cited by clinicians include time constraints [21], insufficient confidence and training [22] and discomfort when addressing alcohol use with patients [23]. Lack of institutional support [24] and insufficient financial incentives [25] further contribute to low uptake.
Conversely, several facilitators may support broader BI adoption. These include stronger links with specialised services, involvement of additional staff (e.g., nurses), public education campaigns and increased media attention [19].
Research objectives
Although the effectiveness of BI in reducing alcohol-related harm is well-documented, implementation in clinical practice remains inconsistent, particularly in Czechia. Despite WHO re-commendations and proven cost-effectiveness, many general practitioners (GPs) do not routinely use BI even in cases where patients exhibit risky drinking behaviour. This gap between evidence and practice is especially concerning given the high national prevalence of hazardous and harmful alcohol consumption [8, 9].
To better understand this discrepancy, our study explores the perspectives of Czech GPs who actively deliver BI. Specifically, it addresses two key research questions:
1. How is BI perceived by participating GPs? While BI is promoted as an effective preventive tool, little is known about how Czech GPs evaluate its relevance, feasibility and impact in real-world clinical settings.
2. What are the main perceived barriers to BI implementation and what strategies could overcome them? Previous studies point to time constraints, lack of training and limited institutional support as key challenges [18, 19].
This study examines these barriers in the Czech context and identifies practical solutions to support wider BI adoption in primary care.
■ MATERIAL AND METHODS
This study employed a two-round Delphi survey to assess GPs perceptions of the effectiveness of BI, identify barriers to implementation and explore potential solutions to improve BI adoption in clinical practice. The Delphi method was chosen
as it allows for a structured process of gathering expert opinions while refining consensus through multiple rounds of feedback. This iterative approach is particularly effective for complex healthcare topics where expert agreement is essential to guide practice and policy recommendations. The method enables participants to reconsider their initial responses based on anonymised group feedback, reducing the influence of dominant voices and improving the reliability of findings. In addition, this method of data collection is commonly used, for example, when gathering opinions from GPs or other healthcare specialists and seeking consensus [26-28].
In this study, two rounds of structured questionnaires were distributed to a panel of GPs in the Czech Republic. Responses from the first round informed adjustments in the second round, aiming to refine expert consensus on key aspects of BI, including effectiveness, barriers, cost considerations and strategies for improving implementation.
Characteristics of the participants
A publicly available database of general practitioners was generated from the National Register of Healthcare Providers. From this database, a random sampling approach was applied to select 100 GPs, who were then invited to participate via email. The selection process ensured that all GPs in the register had an equal probability of being contacted. The email invitation included details of the purpose of the study, its methodology and the voluntary nature of participation. The only inclusion criterion explicitly stated in the invitation was that participants had to be general practitioners actively delivering BI in their primary care practice.
In the first round, 20 GPs completed the questionnaire and provided initial responses on key aspects of BI. In the second round, 18 GPs participated, refining their opinions on the basis of anonymised group feedback. The dropout rate between rounds was minimal, ensuring consistency of expert input. To encourage participation and compensate for their time, respondents who completed both rounds of the survey were offered a financial incentive of CZK 3,000 (approximately EUR 120).
This combined approach of random selection for invitation and voluntary participation for inclusion helped to minimise selection bias and improve the generalisability of the findings within the Czech GP population. The final sample consisted of practitioners actively engaged in brief alcohol interventions, ensuring that the insights obtained were directly relevant to real-world implementation.
Survey procedure
The Delphi survey was conducted in two rounds using online questionnaires. Participants had seven days to complete each round, with a reminder email sent one day before the deadline to encourage participation.
In both rounds, the questionnaire remained the same, covering key areas related to the effectiveness of BI, barriers to implementation and potential solutions for improving its adoption. In the second round, participants were shown anonymised aggregated results from the first round, including the distribution of responses in percentage form. This allowed them to reconsider their previous answers in the light of the overall expert opinion while maintaining anonymity. The questionnaire was structured into four main areas:
perceived effectiveness of BI, time and cost estimates, barriers to implementation and potential strategies for improving BI adoption.
Two rounds were deemed sufficient to reach expert consensus as is common practice in Delphi studies [29, 30]. Previous research has demonstrated that additional rounds beyond the second often lead to diminishing returns in terms of refining agreement while increasing the risk of participant fatigue and dropout.
Data analysis
The data analysis focused on quantifying consensus levels among participants and identifying any changes in response between the two Delphi rounds. For most questions, respondents answered using a four-point Likert scale with completely disagree, rather disagree, rather agree and completely agree as the response options. This format was chosen to capture variations in agreement levels while avoiding a neutral midpoint, thereby encouraging participants to take a clear stance.
Some questions were formulated separately based on the three main alcohol-consumption risk categories as defined by the Alcohol Use Disorders Identification Test (AUDIT). This categorisation allowed for a more precise evaluation of BI effectiveness depending on the severity of alcohol consumption:
• Risky drinking – patients typically consume three or more standard alcoholic drinks per drinking day and have occasionally consumed six or more drinks on a single occasion.
• Risk of alcohol dependence – in the past year, patients have experienced at least one of the following: inability to stop drinking once they started, failure to meet expected obligations due to drinking or the need to drink in the morning to recover from excessive alcohol consumption.
• Risk of alcohol-related harm – in the past year, patients have experienced at least one of the following: feelings of guilt or regret after drinking, memory loss due to drinking, injuries related to alcohol consumption, or concerns expressed by a doctor, relative or acquaintance recommending that they reduce their drinking.
Consensus was measured using percentage agreement, with a threshold of 75% agreement (sum of rather agree and completely agree) considered as strong consensus, which is a common criterion in Delphi studies [31-33].
Changes between the rounds were assessed by comparing the proportion of participants selecting specific response options in the first and second rounds. For each survey question, the following aspects were analysed:
• Shifts in agreement levels – differences in the proportion of participants selecting rather agree or completely agree across the two rounds.
• Stability of responses – the extent to which opinions remained consistent or showed convergence toward consensus.
• Final consensus – identification of areas where agreement levels increased or remained stable at or above the predefined threshold.
Descriptive statistics were used to summarise the results, with tabular representation to highlight areas of consensus or where shifts in agreement occurred. The final interpretation focused on identifying stable agreements, areas of growing consensus and topics with continued divergence that may require further investigation.
■ RESULTS
The Delphi results confirmed that Czech GPs generally perceive BI as an effective tool for addressing problematic alcohol use, particularly for high-risk drinkers and individuals at risk of dependence. There was also strong support for offering BI consistently to patients in these groups. However, GPs were less confident about the impact of BI on patients at risk of alcohol-related harm, and some skepticism remained about the sustainability of its effects over time. Most participants agreed that patients tend to return to previous drinking levels within a year, highlighting a perceived need for follow-up care. While the short-term benefits of BI are acknowledged, concerns persist about its long-term effectiveness, especially without access to specialist support services. These insights underscore the importance of better integration of BI into a broader care continuum and may help explain why its routine adoption remains limited despite its proven efficacy (Table I).
GPs in the study expressed strong agreement that brief interventions can be delivered efficiently within a typical consultation (5-10 minutes) without any significant disruption to workflow. While there was clear consensus on the overall cost-effectiveness of BI, individual estimates of associated time and material costs showed notable variability. This likely reflects differences in practice organisation, awareness of actual costs or subjective valuation of time. Opinions on the involvement of additional personnel were mixed, though some GPs indicated that modest administrative support could facilitate implementation (Table II).
Perceptions of BI impact on alcohol consumption varied across patient groups. For risky drinkers, GPs reached consensus on a two-drink weekly reduction, suggesting a shared expectation of meaningful change. In contrast, estimates for patients at risk of dependence or alcohol-related harm were more divergent and no consensus emerged. This variability may reflect uncertainty about BI’s effectiveness in more severe cases or differences in clinical experience with these patient groups. Interestingly, average reduction estimates declined in the second round across all categories, possibly due to recalibration after reflecting on peer feedback (Table III).
Stigma and financial disincentives emerged as the most widely acknowledged barriers to BI adoption. All GPs agreed that stigma surrounding alcohol use is a key challenge, while nearly nine in ten also highlighted the lack of financial incentives. Although time constraints gained more support in the second round, they narrowly missed the consensus threshold. Other potential barriers like insufficient training or limited collaboration across disciplines, revealed more divided opinions suggesting that while structural challenges are clearly recognised, views on practical implementation vary considerably (Table IV).
GPs expressed strong support for a broad set of measures to improve BI implementation – full consensus was reached on the importance of training, clear materials and public awareness campaigns. Digital tools and financial incentives were also highly endorsed, each reaching 94% agreement. Likewise, interdisciplinary collaboration received strong support, underlining the value of both structural improvements and better communication across healthcare levels (Table V).
DISCUSSION
BI effectiveness
The results showed a high level of agreement among GPs on the effectiveness of BI in reducing alcohol consumption, with consensus achieved across almost all examined risk categories. The highest agreement was observed for patients at risk of alcohol dependence (89%) and risky drinkers (83%), while BI effectiveness for individuals at risk of alcohol-related harm received slightly lower support (72% consensus). Despite empirical evidence suggesting that BI should primarily target individuals in low- and moderate-risk categories, rather than those already dependent on alcohol, Czech GPs considered BI important even for high-risk groups. This finding is in line with previous research, which shows that, although BI is most effective among non-dependent drinkers, many healthcare providers still perceive its value across all levels of risk [11, 12, 34].
The estimated effectiveness aligns closely with findings from existing scientific literature. Based on the results of this survey, it was assumed that BI would lead to an average weekly reduction of 1.83 standard alcoholic drinks for risky drinkers (equivalent to 95 standard drinks per year) and a weekly reduction of 1.69 standard alcoholic drinks for individuals at risk of alcohol-related harm (equivalent to 88 standard drinks per year). These estimates are consistent with values reported in international studies, further reinforcing the credibility of the reported effectiveness of BI [12, 34, 35]. The alignment between GPs estimates and prior research also provides partial validation of the methodological approach used in this study for assessing BI cost-effectiveness.
Moreover, in terms of expected patient outcomes, GPs’ confidence in BI long-term effectiveness varied by consumption category. While 100% of GPs agreed that BI contributes to health improvement for risky drinkers, only 67% agreed on those at risk of alcohol-related harm while 56% of GPs disagreed that BI leads to positive health changes for patients at risk of dependence. Further highlighting this concern, most GPs agreed that patients often return to their previous drinking levels within one year. There was agreement on this statement at 89% for risky drinkers, 100% for those at risk of dependence and 94% for those at risk of alcohol-related harm. These findings reflect broader patterns observed in previous research [12, 19], which reinforces the crucial need for follow-up interventions and specialised care as standalone BI may not be sufficient to sustain long-term behavioural change. Despite these challenges, 94% of GPs maintained that BI remains cost-effective, emphasising its potential to deliver significant public-health benefits at a relatively low cost. This view is also supported by previous studies, which highlighted the favourable cost-benefit profile of BI, especially when applied in primary care settings [12]. These results indicate that while GPs recognise barriers to the implementation of BI and limitations to its long-term effectiveness, they still consider it a practical and efficient tool in primary care settings.
Barriers to BI adoption
The adoption of alcohol BI in routine primary care remains limited due to structural, financial and psychological barriers. Consistent with previous findings [19, 25], this study identified stigma, insufficient financial incentives and time constraints as key obstacles to BI implementation in the Czech healthcare system.
The strongest consensus (100% agreement) was reached on stigma associated with alcohol consumption as a primary barrier to BI adoption. GPs reported that patient resistance, reluctance to engage in discussions about alcohol and lack of motivation often hinder effective intervention. This reflects a common issue highlighted in the literature, where stigma discourages both disclosure and help-seeking, particularly in primary care settings [19]. Stigmatisation may lead patients to underreport their alcohol consumption or avoid consultations altogether, reducing the likelihood of successful intervention. This challenge highlights the need for broader awareness campaigns aimed at normalising discussions around alcohol use and integrating BI as a routine part of primary care.
A lack of financial incentives was also identified as a major barrier, with 89% of GPs agreeing that inadequate reimbursement limits implementation of BI. Unlike other preventive healthcare measures, BI is often not sufficiently compensated, making it financially unfeasible for many providers to integrate into standard care. Given the time and administrative burden associated with BI, the absence of financial support may deter GPs from prioritising these interventions over other clinical duties.
Additionally, time constraints were frequently cited, with 72% of GPs agreeing that BI is too time-consuming to fit into routine consultations. While this figure did not reach the consensus threshold, it suggests that many GPs perceive a lack of flexibility in their schedules. Other studies confirm that competing clinical demands often prevent BI from becoming routine [21, 22]. These concerns emphasise the need for system-wide reforms, including streamlined digital tools to reduce administrative burden and better integration of BI into electronic health record systems.
Potential solutions and policy recommendations
Addressing the barriers to the implementation of BI requires a multifaceted approach that includes education, digital tools, financial reimbursement and systemic policy changes. Based on the results of this study, several key recommendations emerge to improve BI adoption in primary care settings.
Importance of targeted education and training
Full consensus was reached among GPs on the need for comprehensive training and educational materials to support BI implementation. This includes practical guidelines, manuals and workshops focused not only on the technical aspects of conducting BI but also on effective patient communication and referral pathways for further care. Strengthening health literacy among both patients and healthcare professionals could significantly enhance the acceptance and effectiveness of BI. Given the strong agreement on stigma as a key barrier, public awareness campaigns aimed at reducing stigma around alcohol consumption could further support intervention success.
Digital tools to streamline interventions
The integration of digital screening and intervention tools was identified as a promising way to facilitate BI implementation with 94% of GPs supporting their use. Online screening tools and electronic patient records could reduce the time burden on GPs, enabling more systematic alcohol risk assessment and intervention tracking. Additionally,
digital solutions could provide automated patient reminders, self-assessment tools and follow-up monitoring, further enhancing the long-term impact of BI.
Financial reimbursement to improve BI adoption
Financial barriers remain a significant obstacle, with 89% of GPs identifying insufficient financial incentives as a major limitation to BI implementation. To ensure wider adoption, it is necessary to establish financial compensation mechanisms that appropriately reflect the time and effort required for BI delivery. It was 94% of GPs who agreed that financial or other forms of compensation would significantly improve BI integration into routine clinical practice. Potential financial measures might include: a) direct reimbursement for BI delivery, ensuring that GPs are compensated by health insurance providers, b) clear criteria for BI compensation, defining what qualifies as a BI and establishing transparent assessment methods and c) greater financial support for prevention programmes, ensuring that more resources are allocated to primary care alcohol interventions.
Need for a systemic approach and policy adjustments
For BI to be effectively integrated into routine primary care, system-wide policy changes are needed. The current lack of structured coordination between primary care providers and specialised addiction services limits BI effectiveness, particularly for high-risk patients who require ongoing support. It was 94% of GPs who agreed that stronger collaboration between primary care and addiction services is essential. Expanding the availability of addiction treatment centres and referral pathways would ensure that BI served as the first step in a broader continuum of care rather than a standalone measure.
Additionally, a broader public health strategy that includes awareness campaigns, financial incentives and digital health innovations will be essential to overcoming barriers to BI implementation. Without such systemic reforms, BI will remain an underutilised tool in addressing alcohol-related health risks in primary care.
Limitations of the study
Several limitations of this study should be considered. The relatively limited sample size (20 GPs in the first round, 18 in the second) limits generalisability and while participants were randomly invited, only those already engaged in BI responded, potentially introducing selection bias and overrepresenting supportive views. The Delphi method, while effective for achieving consensus, may oversimplify real-world complexities, as its structured format restricts nuanced responses, and anonymised group feedback may lead to conformity, reducing diversity of perspectives. Additionally, GPs’ assessments of BI effectiveness and costs are self-reported and may not fully align with objective outcomes, with a possible overestimation of effectiveness due to the positive bias of providers already engaged in BI. Future research should use longitudinal data to validate BI effectiveness in clinical practice though despite these limitations, the findings highlight key barriers and solutions for improving BI adoption and inform future policy and research directions.
■ CONCLUSIONS
We can conclude that participating GPs in the Czech Republic widely perceive BI as an effective and cost-efficient tool for reducing alcohol consumption, particularly among high-risk drinkers and those at risk of alcohol dependence. However, several barriers hinder their broader implementation with stigma, insufficient financial incentives and time constraints identified as key obstacles. The study underscores the urgent need for BI to be better embedded into routine primary care, as practical barriers currently prevent widespread adoption. Addressing these challenges will require a multi-faceted approach, including targeted education and training, digital tools to streamline interventions, financial incentives and institutional support. Strengthening collaboration between primary care and specialised addiction services is also essential for ensuring long-term effectiveness. Without systemic policy changes and improved institutional support, the potential of BI to reduce alcohol-related harm will remain underutilised in primary care settings.
Acknowledgements/Podziękowania
We would like to express our sincere gratitude to Dr. Bezdíčková and Prof. Mrav-čík for their invaluable assistance with the recruitment of general practitioners for this study. We also acknowledge the financial support provided for this project from the internal grant of the Jan Evangelista Purkyně University under the project UJEP-SGS-2024-45-002-1. Additionally, authors Michael Fanta and Miroslav Barták are grateful for the financial support from the Grant from the Office of the Government of the Czech Republic, AA-00-20 Alcohol under control 2.1 in 2024 and under the Charles University Cooperation Programme, scientific field Health Sciences in 2024.
Financial support/Finansowanie
Grant of the Jan Evangelista Purkyně University under the project UJEP-SGS-2024-
45-002-1 and Grant from the Office of the Government of the Czech Republic, AA-00-20 Alcohol under control 2.1. as well as under the Charles University Cooperation Programme, scientific field Health Sciences in 2024.
Ethics/Etyka
This study was conducted in accordance with ethical guidelines and adhered to the principles of informed consent. No sensitive or personal data were collected, and all participants were provided with detailed information about the study’s purpose, methodology and voluntary nature of participation. GPs were fully informed about the research and their rights
before participation. Participants were assured that their responses would remain confidential and anonymised with no personal identifiers linked to the data.
The work described in this article has been carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) on medical research involving human subjects, Uniform Requirements for manuscripts submitted to biomedical journals and the ethical principles defined in the Farmington Consensus of 1997.
Treści przedstawione w pracy są zgodne z zasadami Deklaracji Helsińskiej odnoszącymi się do badań z udziałem ludzi, ujednoliconymi wymaganiami dla czasopism biomedycznych oraz z zasadami etycznymi określonymi w Porozumieniu z Farmington w 1997 roku.
References
1. Mitra S, De A, Chowdhury A. Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Transl Gastroenterol Hepatol 2020; 5: 16.
2.
Park SH, Kim DJ. Global and regional impacts of alcohol use on public health: Emphasis on alcohol policies. Clin Mol Hepatol 2020; 26(4): 652-61.
3.
Xiao J, Wang F, Wong NK, Lv Y, Liu Y, Zhong J, et al. Epidemiological realities of alcoholic liver disease: Global burden, research trends, and therapeutic promise. Gene Expr 2020; 20(2): 105-18.
4.
Probst C, Kilian C, Sanchez S, Lange S, Rehm J. The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: A systematic review. Lancet Public Health 2020; 5(6): e324-e332.
5.
Rehm J, Lange S, Probst C, Popova S. Prevalence of binge drinking during pregnancy by country and WHO region: Systematic review and meta-analysis. Reprod Toxicol 2017; 73: 214-21.
6.
Ramalho R. Alcohol consumption and alcohol-related problems during the COVID-19 pandemic: A narrative review. Australas Psychiatry 2020; 28(5): 524-26.
7.
Bloomfield K. Understanding the alcohol-harm paradox: What next? Lancet Public Health 2020; 5: e300-e301.
8.
Czech National Institute of Public Health. National survey on tobacco and alcohol use in the Czech Republic 2023. Prague: Czech National Institute of Public Health; 2024. https://szu.gov.cz/wp-content/uploads/2024/06/Narodni-vyzkum-uzivani-tabaku-a-alkoholu-v-Ceske-republice-2023-3.pdf (Accessed: 03.10.2024).
9.
Mravčík V, Chomynová P, Nechanská B, Černíková T, Csémy L. Alcohol use and its consequences in the Czech Republic. Cent Eur J Public Health 2019; 27(Suppl): S15-S28.
10.
Babor TF, Del Boca F, Bray JW. Screening, brief intervention and referral to treatment: Implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction 2017; 112: 110-17.
11.
O’Connor EA, Perdue LA, Senger CA, Rushkin M, Patnode CD, Bean SI, et al. Interventions to reduce unhealthy alcohol use in adolescents and adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2018; 320(18).
12.
Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2(2): CD004148.
13.
Kelly S, Olanrewaju O, Cowan A, Brayne C, Lafortune L. Interventions to prevent and reduce excessive alcohol consumption in older people: A systematic review and meta-analysis. Age Ageing 2018; 47(2): 175-84.
14.
Barata IA, Shandro JR, Montgomery M, Polansky R, Sachs CJ, Duber HC, et al. Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review. West J Emerg Med 2017; 18(6): 1143-52.
15.
Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; 2016(1): CD008969.
16.
Haug S, Paz Castro R, Kowatsch T, Filler A, Dey M, Schaub MP. Efficacy of a web-and text messaging-based intervention to reduce problem drinking in adolescents: Results of a cluster-randomized controlled trial. J Consult Clin Psychol 2017; 85(2): 147-59.
17.
Glass JE, Andréasson S, Bradley KA, Wallhed Finn S, Williams EC, Bakshi AS. Rethinking alcohol interventions in health care: A thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12(1): 14. DOI: 10.1186/s13722-017-0079-8.
18.
Williams EC, Achtmeyer CE, Young JP, Berger D, Curran G, Bradley KA, et al. Barriers to and facilitators of alcohol use disorder pharmacotherapy in primary care: A qualitative study in five VA clinics. J Gen Intern Med 2018; 33: 258-67.
19.
Rosario F, Santos MI, Angus K, Pas L, Ribeiro C, Fitzgerald N. Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: A systematic review using the COM-B system. Implement Sci 2021; 16: 6.
20.
McNeely J, Kumar PC, Rieckmann T, Sedlander E, Farkas S, Chollak C, et al. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: A qualitative study of patients, providers, and staff. Addict Sci Clin Pract 2018; 13(1): 8. DOI: 10.1186/s13722-018-0110-8.
21.
Tansil KA, Esser MB, Sandhu P, Reynolds JA, Elder RW, Williamson RS, et al. Alcohol electronic screening and brief intervention: A community guide systematic review. Am J Prev Med 2016; 51(5): 801-11.
22.
Nunes AP, Richmond MK, Marzano K, Swenson CJ, Lockhart J. Ten years of implementing screening, brief intervention, and referral to treatment (SBIRT): Lessons learned. Subst Abuse 2017; 38(4): 508-12.
23.
Derges J, Kidger J, Fox F, Campbell R, Kaner E, Hickman M. Alcohol screening and brief interventions for adults and young people in health and community-based settings: A qualitative systematic literature review. BMC Public Health 2017; 17: 562.
24.
DiMartini AF, Leggio L, Singal AK. Barriers to the management of alcohol use disorder and alcohol-associated liver disease: Strategies to implement integrated care models. Lancet Gastroenterol Hepatol 2022; (7)2: 186-95.
25.
Keurhorst M, Heinen M, Colom J, Linderoth C, Müssener U, Okulicz-Kozaryn K, et al. Strategies in primary healthcare to implement early identification of risky alcohol consumption: Why do they work or not? BMC Fam Pract 2016; 17(70): 1-16.
26.
Richard B, Moussaoui S, Bonello K, Skendi M. Assessing the acceptability to general practitioners of the French College of General Medicine’s recommendations on considering patients’ social situations: A Delphi study. BMJ Open 2024; 14(12): e084837.
27.
Apalla Z, Freites‐Martinez A. Management of human epidermal growth factor receptor inhibitors‐related acneiform rash: A position paper based on the first Europe/USA Delphi consensus process. J Eur Acad Dermatol Venereol 2025; 39: 730-41.
28.
Klepacz N, Simons G. Measurement matters: developing core outcome sets for measuring doctor and nurse wellbeing. Presented at: HSRUK 2024; July 8-10 2024, Oxford, United Kingdom.
29.
Sellers D, Crilly J, Hughes L, Ranse J. Disaster Preparedness for Intensive Care Units: Priorities to Inform Crisis Standards of Care. Aust Crit Care 2025; (38)2: 101142.
30.
Gao J, Neo YW, Soo S, Teng PHJ, Nai ZL, Chan EY. Developing a multicomponent intervention for family caregivers of older adults in Singapore: A Delphi study. Health Soc Care Community 2025; 2025: 8495394.
31.
Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 2014; 67(4): 401-9.
32.
Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: how to decide its appropriateness. World J Methodol 2021; 11(4): 116-24.
33.
Similä E, Jyrkkä J, Airaksinen M, Toivo T. Development and validation of the National High-Risk Medicine Classification using the Delphi method. Res Social Adm Pharm 2025; 21(5): 371-91.
34.
Sullivan LE, Tetrault JM, Braithwaite RS, Turner BJ, Fiellin DA. A meta‐analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient‐centered medical home. Am J Addict 2011; 20(4): 343-56.
35.
Donoghue K, Patton R, Phillips T, Deluca P, Drummond C. The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: a systematic review and meta-analysis. J Med Internet Res 2014; 16(6): e142.
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