Support can increase use of the AUDIT‐C in Australian Aboriginal Community Controlled Health Services: a cluster randomized trial

Abstract

Background and Aims Unhealthy alcohol consumption is a key concern for Aboriginal and Torres Strait Islander ('Indigenous') communities. It is important to identify and treat at-risk drinkers, to prevent harms to physical or social wellbeing. We aimed to test whether training and support for Aboriginal Community Controlled Health Service (ACCHS) staff would increase rates of alcohol screening and brief intervention. Design Cluster randomized trial. Setting Australia. Cases/Intervention/Measurements Twenty-two ACCHSs that see at least 1000 clients per year and use Communicare as practice management software. The study included data on 70 419 clients, training, regular data feedback, collaborative support and funding for resources ($9000). Blinding was not used. The comparator was waiting-list control (equal allocation). Alcohol Use Disorder Identification Test (AUDIT-C) screening and records of brief interventions were extracted from practice management software at 2-monthly intervals. Observations described the clinical actions taken for clients over each 2-month interval. The baseline period (28 August 2016-28 August 2017) was compared with the post-implementation period (29 August 2017-28 August 2018). We used multi-level logistic regression to test the hypotheses that clients attending a service receiving active support would be more likely to be screened with AUDIT-C (primary outcome) or to receive a brief intervention (secondary outcome). Findings We observed an increase in the odds of screening with AUDIT-C for both groups, but the increase was 5.52 [95% confidence interval (CI) = 4.31, 7.07] times larger at services receiving support. We found little evidence that the support programme increased the odds of a recorded brief intervention relative to control services (odds ratio = 2.06; 95% CI = 0.90, 4.69). Differences in baseline screening activity between treatment and control reduce the certainty of our findings.Conclusions Providing Aboriginal Community Controlled Health Services with training and support can improve alcohol (AUDIT-C) screening rates.

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

“…Consistent with the results during 12-month active phase [9] Previous studies have shown that multiple organizational levels need to be involved to optimize health service improvement efforts [7,26,27]. Furthermore, the ACCHS' work to sustainably improve Aboriginal and Torres Strait Islander health must be supported by both state and federal government.…”

Patient self‐report versus medical records for smoking status and alcohol consumption at Aboriginal Community Controlled Health Services

“…This may be explained by the convenience nature of our sample, whereby regular patients, with more opportunities for healthcare providers to assess and document their risk status, were possibly more likely to be approached to participate. 24 with many ACCHS clients presenting to primary care with comorbidities and competing health priorities.…”

“…While the RCT improved screening rates, it did not increase the odds of clients receiving brief intervention. 24 Such findings highlight the fact that while screening and documentation of risk factors can act as a prompt for healthcare providers, it does not ensure that preventive care is delivered. Thus, additional strategies will also be needed to help healthcare providers to 'Assess, Advise, Assist, and Arrange support' for those patients identified as at-risk.…”

Effects of service-wide support on regularity of alcohol screening of clients in Australian Aboriginal and Torres Strait Islander Community Controlled Health Services: a cluster randomised trial

“…Training included: harms related to alcohol; current evidence for screening; culturally secure and accurate administration and interpretation of AUDIT-C; use of annual AUDIT-C screening; responding to a positive AUDIT-C screen; and using service-wide screening data to monitor improvements in screening Implementation approaches incorporated cultural protocols of Aboriginal and Torres Strait peoples such as gender appropriateness, kinship systems and cultural obligations Face-to-face workshops were delivered by an addiction medicine specialist and an Aboriginal health professional (e.g., drug and alcohol worker or other) 4 Data feedback report, based on the bi-monthly data provided by services Graphic representation of proportion of clients screened; proportion drinking at risky levels as measured by AUDIT-C; as well as overall rate of screening over 2-month periods and the last 12-months; and recorded treatment provided Presented as a pdf file with graphics and emailed to service champions and key contacts 5 Bi-monthly teleconference for service champions to exchange improvement ideas and experiences 6 Support to modify practice software to facilitate screening such as inclusion of AUDIT-C in the Adult Health Check, and other electronic forms used for periodic and opportunistic health checks, e.g., over 50 s, pregnancy, pre-consult examination 7 A website with a repository of electronic tools and resources, including screening resources and standard drinks charts, and a private chat platform for champions 8 Financial support for purchase of agreed resources e.g., standard drink cups, clinical handbooks, prevention materials a This table emphasises the screening-specific content of the support model. Fuller description, including elements supporting alcohol treatment, has been published elsewhere [ 12 , 15 ] …”