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Dzidowska M, Lee KSK, Conigrave JH, et al. Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial. Addiction. 2021;doi: 10.1111/add.15712.
Dzidowska, M., Lee, K. S. K., Conigrave, J. H., Dobbins, T. A., Hummerston, B., Wilson, S., Haber, P. S., Gray, D., & Conigrave, K. M. (2021). Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial. Addiction (Abingdon, England), . https://doi.org/10.1111/add.15712
Dzidowska, Monika, et al. "Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial." Addiction (Abingdon, England) vol. (2021). doi: https://doi.org/10.1111/add.15712
Dzidowska M, Lee KSK, Conigrave JH, Dobbins TA, Hummerston B, Wilson S, Haber PS, Gray D, Conigrave KM. Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial. Addiction. 2021 Oct 04; doi: 10.1111/add.15712. Epub 2021 Oct 04. PMID: 34605084.
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Addiction. 2021 Oct 04; doi: 10.1111/add.15712. Epub 2021 Oct 04.

Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial.

Addiction (Abingdon, England)

Monika Dzidowska, K S Kylie Lee, James H Conigrave, Timothy A Dobbins, Beth Hummerston, Scott Wilson, Paul S Haber, Dennis Gray, Katherine M Conigrave

Affiliations

  1. Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.
  2. The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health Services, Royal Prince Alfred Hospital (KGV), Camperdown, NSW, Australia.
  3. National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
  4. Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.
  5. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
  6. Aboriginal Health Council of South Australia, Adelaide, SA, Australia.
  7. Aboriginal Drug and Alcohol Council (SA) Aboriginal Corporation, Adelaide, SA, Australia.

PMID: 34605084 DOI: 10.1111/add.15712

Abstract

BACKGROUND AND AIMS: There is a higher prevalence of unhealthy alcohol use among Indigenous populations, but there have been few studies of the effectiveness of screening and treatment in primary health care. Over 24 months, we tested whether a model of service-wide support could increase screening and any alcohol treatment.

DESIGN: Cluster-randomized trial with 24-month implementation (12 months active, 12 months maintenance).

SETTING: Australian Aboriginal Community Controlled primary care services.

PARTICIPANTS: Twenty-two services (83 032 clients) that use Communicare practice software and see at least 1000 clients annually, randomized to the treatment arm or control arm.

INTERVENTION AND COMPARATOR: Multi-faceted early support model versus a comparator of waiting-list control (11 services).

MEASUREMENTS: A record (presence = 1, absence = 0) of: (i) Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening (primary outcome), (ii) any-treatment and (iii) brief intervention. We received routinely collected practice data bimonthly over 3 years (1-year baseline, 1-year implementation, 1-year maintenance). Multi-level logistic modelling was used to compare the odds of each outcome before and after implementation.

FINDINGS: The odds of being screened within any 2-month reference period increased in both arms post-implementation, but the increase was nearly eight times greater in early-support services [odds ratio (OR) = 7.95, 95% confidence interval (CI) = 4.04-15.63, P < 0.001]. The change in odds of any treatment in early support was nearly double that of waiting-list controls (OR = 1.89, 95% CI = 1.19-2.98, P = 0.01) but was largely driven by decrease in controls. There was no clear evidence of difference between groups in the change in the odds of provision of brief intervention (OR = 1.95, 95% CI = 0.53-7.17, P = 0.32).

CONCLUSIONS: An early support model designed to aid routine implementation of alcohol screening and treatment in Aboriginal health services resulted in improvement of Alcohol Use Disorders Identification Test-Consumption screening rates over 24 months of implementation, but the effect on treatment was less clear.

© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Keywords: AUDIT-C; Alcohol; Indigenous; alcohol screening; brief intervention; continuous quality improvement; primary care; training and support; treatment

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