Table 1 Outline of intervention groups with three different implementation strategies

1.

Control Group—treatment as usual: The control group will receive a package, either hand-delivered or by post, containing a summary card of the national guideline recommendation for screening and brief advice for hazardous and harmful alcohol consumption, without demonstration. In Poland, where no national guidelines exist, the summary card will be adapted from the PHEPA guidelines for the purposes of this trial [33]. No further instructions will be given.

2.

Training and support: Countries differ largely with regard to usual T&S and other educational training of primary care staff. To maximise comparability, a set of minimal and maximal criteria have been established, in which each country specific T&S package should fit.

In addition to receiving the same package as the control group, the T&S group will be offered two initial 1 to 2 hours face-to-face educational trainings, and one (10 to 30 min) telephone support call to the lead PHCU contact person during the twelve week implementation period. If necessary, one additional face-to-face training of 1 to 2 h duration will be offered. The time intervals between the initial training, the telephone call, and the additional optional training will be, on average, two weeks. The training addresses knowledge, skills, attitudes, and perceived barriers and facilitators in implementing screening and brief advice, combining theory and practical exercises. The location of the educational training will vary from country to country and include in-house meetings at the PHCU or within clusters of PHCUs. The trainers will include peer trainers, members of the research team, accredited teachers, or addiction consultants. Each country will use an adapted existing country-based T&S package. In the case of Poland, the T&S package will be based on the PHEPA training program.

3.

Financial reimbursement: In addition to receiving the same package as the control group, financial reimbursement groups will be paid for their registered screening and brief intervention activities. Payment depends on normal country specific fees and rates for financial reimbursement for clinical preventive activities.

4.

e-BI: In addition to receiving the same package as the control group, the e-BI group will be asked to refer identified at risk patients with an e-leaflet with unique log in codes to an approved e-BI specific package, which will be country specific, or, for Poland based on the WHO e-SBI program. The website should include the following: Log-in facility to allow monitoring of the patient (i.e., patient actually log-in); suitable brief screening tool with ability to calculate score and give feedback (i.e., brief intervention); appropriate information on sensible drinking guidelines; information on impact of alcohol on health and wellbeing; and a drink diary facility. Furthermore, the website could offer reminder facilities for follow-up activity.

5.

T&S and financial reimbursement: The T&S and financial reimbursement group will receive the package, T&S, and the financial reimbursement as described above.

6.

T&S and e-BI: The T&S and e-BI group will receive the package, T&S as above, and will be asked to refer identified at risk patients to e-BI as above.

7.

Financial reimbursement and e-BI: The financial reimbursement and e-BI group will receive the package and will be asked to refer identified at risk patients to e-BI as above. They will be paid for screening, referral performance to e-BI, and brief advice if actually delivered, with the system of pay as above.

8.

T&S, financial reimbursement and e-BI: The T&S, financial reimbursement and e-BI group will receive the package and T&S as above. They will be asked to refer identified at risk patients to e-BI as above. They will be paid for screening, brief advice activities, and referral performance to e-BI, with the system of pay as above.