Supporting alcohol brief interventions and pharmacotherapy provision in Australian First Nations primary care: exploratory analysis of a cluster randomised trial.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Monika Dzidowska, K S Kylie Lee, James H Conigrave, Scott Wilson, Noel Hayman, Rowena Ivers, Julia Vnuk, Paul Haber, Katherine M Conigrave
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Abstract

Introduction: Primary care provides an important opportunity to detect unhealthy alcohol use and offer assistance but many barriers to this exist. In an Australian context, Aboriginal Community Controlled Health Services (ACCHS) are community-led and run health services, which provide holistic primary care to Aboriginal and Torres Strait Islander peoples. A recent cluster randomised trial conducted with ACCHS provided a service support model which showed a small but significant difference in provision of 'any treatment' for unhealthy alcohol use. However, it was not clear which treatment modalities were increased.

Aims: To test the effect of an ACCHS support model for alcohol on: (i) delivery of verbal alcohol intervention (alcohol advice or counselling); (ii) prescription of relapse prevention pharmacotherapies.

Methods: Intervention: 24-month, multi-faceted service support model.

Design: cluster randomised trial; equal allocation to early-support ('treatment') and waitlist control arms.

Participants: 22 ACCHS.

Analysis: Multilevel logistic regression to compare odds of a client receiving treatment in any two-month period as routinely recorded on practice software.

Results: Support was associated with a significant increase in the odds of verbal alcohol intervention being recorded (OR = 7.60, [95% CI = 5.54, 10.42], p < 0.001) from a low baseline. The odds of pharmacotherapies being prescribed (OR = 1.61, [95% CI = 0.92, 2.80], p = 0.1) did not increase significantly. There was high heterogeneity in service outcomes.

Conclusions: While a statistically significant increase in verbal alcohol intervention rates was achieved, this was not clinically significant because of the low baseline. Our data likely underestimates rates of treatment provision due to barriers documenting verbal interventions in practice software, and because different software may be used by drug and alcohol teams. The support made little impact on pharmacotherapy prescription. Changes at multiple organisational levels, including within clinical guidelines for primary care, may be needed to meaningfully improve provision of alcohol treatment in ACCHS.

Trial registration: ACTRN12618001892202 (retrospectively registered on 21/11/2018).

支持在澳大利亚原住民初级保健中提供酒精简短干预和药物治疗:群组随机试验的探索性分析。
导言:初级保健为发现不健康的饮酒行为并提供帮助提供了重要机会,但这方面存在许多障碍。在澳大利亚,原住民社区控制健康服务(ACCHS)是由社区领导和管理的健康服务机构,为原住民和托雷斯海峡岛民提供全面的初级保健服务。最近与 ACCHS 共同开展的一项群集随机试验提供了一种服务支持模式,该模式显示,在为不健康饮酒提供 "任何治疗 "方面存在微小但显著的差异。目的:测试 ACCHS 支持模式对酒精的影响:(目的:测试 ACCHS 酗酒支持模式对以下方面的影响:(i) 提供口头酗酒干预(酗酒建议或咨询);(ii) 处方预防复发的药物疗法:干预措施:为期 24 个月的多方位服务支持模式。设计:分组随机试验;平等分配早期支持("治疗")组和候补对照组。参与者:22 个 ACCHS:分析:多层次逻辑回归,比较实践软件中例行记录的客户在任何两个月内接受治疗的几率:结果:支持与记录的口头酒精干预几率的显著增加有关(OR = 7.60,[95% CI = 5.54,10.42],P 结论:虽然口头酒精干预几率的增加在统计学上有显著意义,但在临床实践中,酒精干预几率的增加并不完全与支持相关:虽然口头酒精干预率在统计学上有了显著提高,但由于基线较低,因此临床意义不大。我们的数据很可能低估了提供治疗的比率,这是因为在实践软件中记录口头干预存在障碍,而且药物治疗小组和酒精治疗小组可能使用不同的软件。支持对药物治疗处方的影响很小。要想切实改善ACCHS中酒精治疗的提供情况,可能需要在多个组织层面(包括在初级保健临床指南中)做出改变:ACTRN12618001892202(于2018年11月21日进行了回顾性注册)。
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