Supporting Aboriginal Community Controlled Health Services to deliver alcohol care: protocol for a cluster randomised controlled trial

Harrison, Kristie; Lee, K. S. Kylie; Dobbins, Timothy; Wilson, Scott; Hayman, Noel; Ivers, Rowena; Haber, Paul S.; Conigrave, James H.; Johnson, David; Hummerston, Beth; Gray, Dennis; Conigrave, Katherine M.

doi:10.1136/bmjopen-2019-030909

Cited by 16 publications

(30 citation statements)

References 36 publications

(40 reference statements)

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“…Four authors of this paper identify as Indigenous Australian. on-site training, resources, practice management software support, regular data feedback, telephone conferences and an on-line information repository and an on-line platform [11].…”

Section: Involvement By Indigenous Australiansmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Involvement By Indigenous Australiansmentioning

confidence: 99%

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

et al. 2021

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“…For example, First Nations communities have expressed concern over ethical issues with RCT designs (withholding beneficial treatment from one part of the community) [ 103 ]. Alternative study designs such as the ‘stepped-wedge trial’ and ‘wait-list control’ have been approved as culturally safe by several communities [ 86 , 104 ]. Given the cultural diversity within First Nations tribal groups, tailoring of treatment approaches to suit local cultural beliefs, values, protocols, and communication preferences is encouraged to promote client engagement with primary care services.…”

Section: Discussionmentioning

confidence: 99%

What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada

Purcell‐Khodr

Lee

Conigrave

et al. 2020

Addict Sci Clin Pract

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Background: First Nations peoples of Australia, New Zealand, the United States of America (USA) and Canada are more likely to be non-drinkers than other people in these countries. However, those who do drink may be at greater risk of alcohol-related harms (at a population level) due to the ongoing impacts from colonisation and associated oppression. Addressing unhealthy drinking (drinking above recommended limits including alcohol use disorders) in primary care settings is one important way to increase accessibility of treatment. Methods: This systematic review identifies peer-reviewed studies of alcohol treatments delivered in primary care or other non-residential settings for First Nations peoples of Australia, New Zealand, USA and Canada. Literature searches were conducted in seven academic databases from their inception until March, 2020. We assessed evidence of treatment or implementation effectiveness, perceived acceptability or accessibility, and the study quality as assessed by the AXIS tool and by a measure of community participation in the research process. Results: Twenty-eight studies were included, published between 1968 and 2018. Studies reported on a range of alcohol treatments, from brief intervention to ambulatory withdrawal management, relapse prevention medicines, and cultural therapies. Brief intervention was the most studied approach. Cultural healing practices and bicultural approaches were a key theme amongst several studies. Four studies measured treatment effectiveness, including one randomised controlled trial (naltrexone vs naltrexone plus sertraline vs placebo) and two uncontrolled trials of disulfiram. Of the six implementation studies, three were (hybrid) effectiveness-implementation designs. Most of the remaining studies (n = 21) focused on treatment accessibility or acceptability. Community participation in the research process was poorly reported in most studies. Conclusions: Research evidence on how best to care for First Nations peoples with unhealthy alcohol use is limited. Trials of naltrexone and disulfiram presented promising results. Cultural and bicultural care were perceived as highly important to clinical staff and clients in several studies. More effectiveness studies on the full scope of alcohol treatments are needed. Greater community participation in research and more transparent reporting of this in study methods will be key to producing quality research that combines scientific rigour with cultural appropriateness.

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“…EMRs can also be used to evaluate implementation facilitators and barriers and potentially assist in recruitment by earlier screening for alcohol problems [60]. Data linkage with repositories of primary care clinical data will significantly improve our capacity to evaluate treatment in these settings [61]. While these systems may already be utilised consistently in some countries they are not in many regions.…”

Section: Methods Of Data Collectionmentioning

confidence: 99%

Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: a systematic review

et al. 2020

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Background Pharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited. Primary care could be a key setting for identification and continuous care for AUD due to accessibility, low cost and acceptability to patients. We aimed to synthesise the literature regarding differential models of care for the management of AUD in primary health care settings. Methods We conducted a systematic review of articles published worldwide (1998-present) using the following databases; Medline, PsycINFO, Cochrane database of systematic reviews, Cochrane Central Register of Controlled Trials and Embase. The Grey Matters Tool guided the grey literature search. We selected randomised controlled trials evaluating the effectiveness of a primary care model in the management of AUD. Two researchers independently assessed and then reached agreement on the included studies. We used the Cochrane risk of bias tool 2.0 for the critical appraisal. Results Eleven studies (4186 participants) were included. We categorised the studies into ‘lower’ versus ‘higher’ intensity given the varying intensity of clinical care evaluated across the studies. Significant differences in treatment uptake were reported by most studies. The uptake of AUD medication was reported in 5 out of 6 studies that offered AUD medication. Three studies reported a significantly higher uptake of AUD medication in the intervention group. A significant reduction in alcohol use was reported in two out of the five studies with lower intensity of care, and three out of six studies with higher intensity of care. Conclusion Our results suggest that models of care in primary care settings can increase treatment uptake (e.g. psychosocial and/or pharmacotherapy) although results for alcohol-related outcomes were mixed. More research is required to determine which specific patient groups are suitable for AUD treatment in primary health care settings and to identify which models and components are most effective. Trial Registration PROSPERO: CRD42019120293.

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Supporting Aboriginal Community Controlled Health Services to deliver alcohol care: protocol for a cluster randomised controlled trial

Cited by 16 publications

References 36 publications

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

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

What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada

Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: a systematic review

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