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

Addiction Science & Clinical Practice

Julia Vnuk¹  Paul Haber²  Monika Dzidowska²  Katherine M. Conigrave²  K. S. Kylie Lee³  Jacques E. Raubenheimer⁴  Timothy A. Dobbins⁵  Noel Hayman⁶ 

[1]Aboriginal Health Council of South Australia, 220 Franklin Street, 5000, Adelaide, SA, Australia

[2]Adelaide Rural Clinical School, The University of Adelaide, Level 1, Helen Mayo North Frome Road, 5005, Adelaide, SA, Australia

[3]Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Lev 6, King George V Building (C39), 2006, Sydney, NSW, Australia

[4]The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health Services, Royal Prince Alfred Hospital (KGV), 83-117 Missenden Road, Camperdown, 2050, Sydney, NSW, Australia

[5]Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Lev 6, King George V Building (C39), 2006, Sydney, NSW, Australia

[6]The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health Services, Royal Prince Alfred Hospital (KGV), 83-117 Missenden Road, Camperdown, 2050, Sydney, NSW, Australia

[7]Faculty of Health Sciences, National Drug Research Institute, Curtin University, 7 Parker Place, Bentley, 6102, Perth, WA, Australia

[8]Centre for Alcohol Policy Research, La Trobe University, NR1, Bundoora, 3086, Melbourne, VIC, Australia

[9]Faculty of Medicine and Health, Translational Australian Clinical Toxicology Program, The University of Sydney, Lev3, 1-3 Ross Street (K06), 2006, Sydney, NSW, Australia

[10]School of Public Health and Community Medicine, University of New South Wales-UNSW, Level 3, Samuels Building Gate 11, Botany Street, 2052, Sydney, NSW, Australia

[11]Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), 37 Wirraway Parade, Inala, 4077, Brisbane, QLD, Australia

[12]Griffith Health Centre (G40), School of Medicine, Griffith University, Gold Coast campus, 4222, Gold Coast, QLD, Australia

[13]School of Medicine, University of Queensland, Herston Road, Herston, 4006, Brisbane, QLD, Australia

关键词: Alcohol;    Training and support;    Alcohol screening;    Screening patterns;    Indigenous;    Aboriginal;    Torres Strait Islander;    Continuous quality improvement;    AUDIT-C;    Primary care;   

DOI  :  10.1186/s13722-022-00294-6

来源: Springer

【 摘 要 】

BackgroundWe have previously shown that service-wide support can increase the odds of alcohol screening in any 2-month period in a cluster randomized trial of service-wide support to Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHS). Here we report an exploratory analysis on whether the resulting pattern of screening was appropriate. Aim: we assess whether that increase in screening was associated with: (i) increased first-time screening, (ii) increased annual screening, (iii) whether frequently screened clients fell into one of four risk categories as defined by national guidelines.MethodsSetting and participants: 22 ACCHS; randomized to receive the support model in the treatment (‘early-support’) arm over 24-months or to the waitlist control arm. Intervention: eight-component support, including training, sharing of experience, audit-and-feedback and resource support. Analysis: records of clients with visits before and after start of implementation were included. Multilevel logistic modelling was used to compare (i) the odds of previously unscreened clients receiving an AUDIT-C screen, (ii) odds of clients being screened with AUDIT-C at least once annually. We describe the characteristics of a sub-cohort of clients who received four or more screens annually, including if they were in a high-risk category.ResultsOf the original trial sample, 43,054 met inclusion criteria, accounting for 81.7% of the screening events in the overall trial. The support did not significantly increase the odds of first-time screening (OR  = 1.33, 95% CI 0.81–2.18, p  = 0.25) or of annual screening (OR  = 0.99, 95% CI 0.42–2.37, p = 0.98). Screening more than once annually occurred in 6240 clients. Of the 841 clients with four or more screens annually, over 50% did not fall into a high-risk category. Females were overrepresented. More males than females fell into high-risk categories.ConclusionThe significant increase in odds of screening observed in the main trial did not translate to significant improvement in first-time or annual screening following implementation of support. This appeared to be due to some clients being screened more frequently than annually, while more than half remained unscreened. Further strategies to improve alcohol screening should focus on appropriate screening regularity as well as overall rates, to ensure clinically useful information about alcohol consumption.Trial Registration ACTRN12618001892202, retrospectively registered 16 November 2018 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001892202.

【 授权许可】

CC BY