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Conigrave JH, Lee KSK, Dobbins T, Wilson S, Padarian J, Ivers R, Morley K, Haber PS, Vnuk J, Marshall K, Conigrave K. No improvement in AUDIT-C screening and brief intervention rates among wait-list controls following support of Aboriginal Community Controlled Health Services: evidence from a cluster randomised trial. BMC Health Serv Res 2024; 24:813. [PMID: 39010081 PMCID: PMC11247787 DOI: 10.1186/s12913-024-11214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND While Aboriginal and Torres Strait Islander Australians are less likely to drink any alcohol than other Australians, those who drink are more likely to experience adverse alcohol-related health consequences. In a previous study, providing Aboriginal Community Controlled Health Services (ACCHSs) with training and support increased the odds of clients receiving AUDIT-C alcohol screening. A follow-up study found that these results were maintained for at least two years, but there was large variability in the effectiveness of the intervention between services. In this study, we use services that previously received support as a comparison group to test whether training and support can improve alcohol screening and brief intervention rates among wait-list control ACCHSs. METHODS Design: Cluster randomised trial using routinely collected health data. SETTING Australia. CASES Twenty-two ACCHSs that see at least 1000 clients a year and use Communicare as their practice management software. Intervention and comparator: After initiating support, we compare changes in screening and brief intervention between wait-list control services and services that had previously received support. MEASUREMENT Records of AUDIT-C screening and brief intervention activity in routinely collected data. RESULTS During the reference period we observed 357,257 instances where one of 74,568 clients attended services at least once during a two-monthly data extraction period. Following the start of support, the odds of screening (OR = 0.94 [95% CI 0.67, 1.32], p = 0.74, [Formula: see text]≈ 0.002) and brief intervention (OR = 1.43 [95% CI 0.69, 2.95], p = 0.34, [Formula: see text]≈ 0.002) did not improve for the wait-list control group, relative to comparison services. CONCLUSIONS We did not replicate the finding that support and training improves AUDIT-C screening rates with wait-list control data. The benefits of support are likely context dependent. Coincidental policy changes may have sensitised services to the effects of support in the earlier phase of the study. Then the COVID-19 pandemic may have made services less open to change in this latest phase. Future efforts could include practice software prompts to alcohol screening and brief intervention, which are less reliant on individual staff time or resources. TRIAL REGISTRATION Retrospectively registered on 2018-11-21: ACTRN12618001892202.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, WA, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Timothy Dobbins
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Scott Wilson
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- Aboriginal Drug and Alcohol Council of South Australia, Adelaide, South Australia, Australia
| | - José Padarian
- Sydney Institute of Agriculture and School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Kirsten Morley
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Paul S Haber
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kushani Marshall
- School of Medicine, The University of Notre Dame, Sydney, NSW, Australia
| | - Kate Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Weatherall TJ, Conigrave JH, Lee KSK, Vnuk J, Ivers R, Hayman N, Wilson S, Gray D, Conigrave KM. Alcohol screening in 22 Australian Aboriginal Community Controlled Health Organisations: Clinical context and who is screened. Drug Alcohol Rev 2024; 43:1226-1234. [PMID: 38639392 DOI: 10.1111/dar.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 02/19/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Alcohol screening among Indigenous Australians is important to identify individuals needing support to reduce their drinking. Understanding clinical contexts in which clients are screened, and which clients are more or less likely to be screened, could help identify areas of services and communities that might benefit from increased screening. METHODS We analysed routinely collected data from 22 Aboriginal Community Controlled Health Organisations Australia-wide. Data collected between February 2016 and February 2021 were analysed using R, and aggregated to describe screening activity per client, within 2-monthly extraction periods. Descriptive analyses were performed to identify contexts in which clients received an Alcohol Use Disorders Identification Test consumption (AUDIT-C) screen. Multi-level logistic regression determined demographic factors associated with receiving an AUDIT-C screen. Three models are presented to examine if screening was predicted by: (i) age; (ii) age and gender; (iii) age, gender and service remoteness. RESULTS We observed 83,931 occasions where AUDIT-C was performed at least once during a 2-monthly extraction period. Most common contexts were adult health check (55.0%), followed by pre-consult examination (18.4%) and standalone item (9.9%). For every 10 years' increase in client age, odds of being screened with AUDIT-C slightly decreased (odds ratio 0.98; 95% confidence interval [CI] 0.98, 0.99). Women were less likely to be screened with AUDIT-C (odds ratio 0.95; 95% CI 0.93, 0.96) than men. DISCUSSION AND CONCLUSIONS This study identified areas where alcohol screening can be increased (e.g., among women). Increasing AUDIT-C screening across entire communities could help reduce or prevent alcohol-related harms. Future Indigenous-led research could help identify strategies to increase screening rates.
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Affiliation(s)
- Teagan J Weatherall
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
- Australian Catholic University, Sydney, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Burnet Institute, Melbourne, Australia
| | - Julia Vnuk
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Brisbane, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Scott Wilson
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Aboriginal Drug and Alcohol Council of South Australia Inc., Adelaide, Australia
| | - Dennis Gray
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
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Conigrave JH, Devine EK, Lee KSK, Dobbins T, Vnuk J, Hayman N, Conigrave K. Unintended consequences: Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns. Drug Alcohol Rev 2023; 42:1633-1638. [PMID: 37867367 PMCID: PMC10946595 DOI: 10.1111/dar.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Regular screening for risky drinking is important to improve the health of Aboriginal and Torres Strait Islander Australians. We explored whether the rate of screening for risky drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions was disrupted at Aboriginal Community Controlled Health Services (ACCHS) during state-wide and territory-wide COVID-19 lockdowns in 2020. METHODS Retrospective analysis of screening data from 22 ACCHSs located in New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia. These services provide holistic and culturally appropriate primary care. A multi-level Poisson regression, including AR(1) autocorrelation, was used to predict counts of AUDIT-C screening at ACCHSs. RESULTS AUDIT-C screening was suppressed during state-wide and territory-wide lockdowns in 2020 (incident rate ratio [IRR] 0.42 [0.29, 0.61]). The effect of lockdowns differed by service remoteness. While there was a substantial reduction in AUDIT-C screening for urban and inner regional services (IRR 0.25 [95% confidence interval (CI) 0.15, 0.42]), there was not a statistically significant change in screening at outer regional and remote (IRR 0.60 [95% CI 0.33, 1.09]) or very remote services (IRR 0.67 [95% CI 0.40, 1.11]). DISCUSSION AND CONCLUSIONS The COVID-19 lockdowns in Australia likely suppressed rates of screening for risky drinking in urban and inner regional regions. As harm from alcohol consumption may have increased during lockdowns, policymakers should consider implementing measures to enable screening for risky drinking to continue during future lockdowns.
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Affiliation(s)
- James H. Conigrave
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
- Centre of Research Excellence in Indigenous Health and AlcoholThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Institute for Positive Psychology and Education, Australian Catholic UniversitySydneyAustralia
| | - Emma K. Devine
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
- Centre of Research Excellence in Indigenous Health and AlcoholThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
- National Drug Research Institute, Faculty of Health Sciences, Curtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
| | | | - Julia Vnuk
- Aboriginal Health Council of South AustraliaAdelaideAustralia
- Adelaide Rural Clinical SchoolThe University of AdelaideAdelaideAustralia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health CareBrisbaneAustralia
- School of MedicineUniversity of QueenslandBrisbaneAustralia
- School of MedicineGriffith University, Gold Coast CampusGold CoastAustralia
| | - Katherine Conigrave
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
- Centre of Research Excellence in Indigenous Health and AlcoholThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyAustralia
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Purcell‐Khodr G, Conigrave JH, Lee KSK, Vnuk J, Conigrave KM. Low rates of prescribing alcohol relapse prevention medicines in Australian Aboriginal Community Controlled Health Services. Drug Alcohol Rev 2023; 42:1606-1616. [PMID: 37422892 PMCID: PMC10947357 DOI: 10.1111/dar.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Alcohol dependence is a chronic condition impacting millions of individuals worldwide. Safe and effective medicines to reduce relapse can be prescribed by general practitioners but are underutilised in the general Australian population. Prescription rates of these medicines to Aboriginal and Torres Strait Islander (First Nations) Australians in primary care are unknown. We assess these medicines in Aboriginal Community Controlled Health Services and identify factors associated with prescription. METHODS Baseline data (spanning 12 months) were used from a cluster randomised trial involving 22 Aboriginal Community Controlled Health Services. We describe the proportion of First Nations patients aged 15+ who were prescribed a relapse prevention medicine: naltrexone, acamprosate or disulfiram. We explore associations between receiving a prescription, a patient AUDIT-C score and demographics (gender, age, service remoteness) using logistic regression. RESULTS During the 12-month period, 52,678 patients attended the 22 services. Prescriptions were issued for 118 (0.2%) patients (acamprosate n = 62; naltrexone n = 58; disulfiram n = 2; combinations n = 4). Of the total patients, 1.6% were 'likely dependent' (AUDIT-C ≥ 9), of whom only 3.4% received prescriptions for these medicines. In contrast, 60.2% of those who received a prescription had no AUDIT-C score. In multivariate analysis, receiving a script (OR = 3.29, 95% CI 2.25-4.77) was predicted by AUDIT-C screening, male gender (OR = 2.24, 95% CI 1.55-3.29), middle age (35-54 years; OR = 14.41, 95% CI 5.99-47.31) and urban service (OR = 2.87, 95% CI 1.61-5.60). DISCUSSION AND CONCLUSIONS Work is needed to increase the prescription of relapse prevention medicines when dependence is detected. Potential barriers to prescription and appropriate ways to overcome these need to be identified.
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Affiliation(s)
- Gemma Purcell‐Khodr
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Rural Health, Faculty of Medicine and HealthThe University of SydneyDubboAustralia
| | - James H. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Institute for Positive Psychology and EducationAustralian Catholic UniversitySydneyAustralia
| | - K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health ServicesSydney Local Health DistrictSydneyAustralia
- National Drug Research InstituteCurtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Julia Vnuk
- Aboriginal Health Council of South AustraliaAdelaideAustralia
- Adelaide Rural Clinical School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - Katherine M. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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Conigrave JH, Lee KSK, Haber PS, Vnuk J, Doyle MF, Conigrave KM. More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments. Addict Sci Clin Pract 2022; 17:23. [PMID: 35382880 PMCID: PMC8981780 DOI: 10.1186/s13722-022-00306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander ('Indigenous') Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments. METHODS We performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score. RESULTS The primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients. CONCLUSIONS Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported.
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Affiliation(s)
- James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- La Trobe University, Centre for Alcohol Policy Research, Bundoora, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Paul S Haber
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, SA, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
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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 2022; 117:796-803. [PMID: 34605084 PMCID: PMC9298002 DOI: 10.1111/add.15712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Monika Dzidowska
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthWAAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVICAustralia
| | - James H. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - Timothy A. Dobbins
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Beth Hummerston
- Aboriginal Health Council of South AustraliaAdelaideSAAustralia
| | - Scott Wilson
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- Aboriginal Drug and Alcohol Council (SA) Aboriginal CorporationAdelaideSAAustralia
| | - Paul S. Haber
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - Dennis Gray
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthWAAustralia
| | - Katherine M. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
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Dzidowska M, Raubenheimer JE, Dobbins TA, Lee KSK, Hayman N, Vnuk J, Haber P, Conigrave KM. 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. Addict Sci Clin Pract 2022; 17:13. [PMID: 35183257 PMCID: PMC8858520 DOI: 10.1186/s13722-022-00294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background We 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. Methods Setting 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. Results Of 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. Conclusion The 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. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00294-6.
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Weatherall TJ, Conigrave JH, Conigrave KM, Perry J, Wilson S, Room R, Chikritzhs T, Kylie Lee KS. Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians: harms, getting help and awareness of local treatments. Addict Sci Clin Pract 2021; 16:65. [PMID: 34715909 PMCID: PMC8555222 DOI: 10.1186/s13722-021-00274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have examined links between current alcohol dependence and specific harms among Indigenous Australians. We investigated these associations as well as help seeking for drinking, awareness of local treatments and recommendations to help family or friends cut down or stop drinking in two Indigenous communities. Methods A representative sample of Indigenous Australians was surveyed in one urban and one remote community in South Australia. Data were collected via the Grog Survey App. Participants were dependent if they reported two or more symptoms of alcohol dependence (ICD-11). Pearson chi-square tests were used to describe relationships between employment by gender, and dependence by awareness of medicines and local treatment options. Multivariate logistic regressions were used to predict the odds of dependent drinkers experiencing harms and getting help for drinking, controlling for age, gender, schooling and income. Results A total of 775 Indigenous Australians took part in the study. After controlling for confounders, dependent drinkers were nearly eight times more likely to report a harm and nearly three times more likely to get help for their drinking—compared with non-dependent drinkers. Participants recommended accessing local support from an Aboriginal alcohol and other drugs worker, or a detoxification/ rehabilitation service. Discussion and conclusions More support and funding is needed for Indigenous Australians to ensure local treatment options for dependent drinkers are readily available, appropriate and accessible. Involvement of local Aboriginal or Torres Strait Islander health professionals in delivery of care can help ensure that it is appropriate to an individual’s culture and context.
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Affiliation(s)
- Teagan J Weatherall
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia. .,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia. .,Faculty of Medicine and Health, Discipline of Addiction Medicine, Indigenous Health and Substance Use, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - James H Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council South Australia, Underdale, SA, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Aboriginal Drug and Alcohol Council South Australia, Underdale, SA, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,Burnet Institute, Melbourne, VIC, Australia
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James DB, Lee KSK, Dronavalli M, Courtney RJ, Conigrave KM, Conigrave JH, Shakeshaft A. Predictors of length of treatment, discharge reason, and re-admission to Aboriginal alcohol and other drug residential rehabilitation services in New South Wales, Australia. Drug Alcohol Rev 2021; 41:603-615. [PMID: 34644427 DOI: 10.1111/dar.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aboriginal clients accessing Aboriginal community-controlled residential alcohol and other drug rehabilitation services in New South Wales, Australia believe they have better outcomes due to culturally appropriate care. However, there is a paucity of published treatment outcome data. This study aims to identify predictors of treatment outcomes based on client characteristics at intake. METHODS A cross-sectional, retrospective, observational study of 2326 admissions to six services between January 2011 and December 2016. The outcomes were: (i) leaving treatment early; (ii) self-discharge or house discharge (by staff); and (iii) re-admission within two years. The predictors examined were Aboriginal status, age, justice system referral and primary substance of concern. Competing risk and Poisson regression analyses were used to identify trends in the data. RESULTS The mean age of clients was 33 years, and the majority (56%) stayed at least 6 weeks. Aboriginal clients whose primary substance of concern was stimulants were almost eight times more likely to re-admitted within 2 years than other clients (risk ratio 7.91; P < 0.001). Aboriginal clients who were also referred from justice were more likely to self-discharge (risk ratio 1.87; P < 0.001). Furthermore, Aboriginal clients who were aged older than 30 were less likely to have a re-admission (risk ratio 0.32; P ≤ 0.001). DISCUSSION AND CONCLUSIONS This study showed client characteristics that are predictive of harmful outcomes include age under 30, justice client, primary substance of use and their interactions. Future research could build on these results to aid ongoing development of residential rehabilitation programs for Aboriginal peoples.
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Affiliation(s)
- Doug B James
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Mithilesh Dronavalli
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Ryan J Courtney
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,Burnet Institute, Melbourne, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - James H Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Anthony Shakeshaft
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Noble N, Bryant J, Maher L, Jackman D, Bonevski B, Shakeshaft A, Paul C. Patient self-report versus medical records for smoking status and alcohol consumption at Aboriginal Community Controlled Health Services. Aust N Z J Public Health 2021; 45:277-282. [PMID: 33970509 DOI: 10.1111/1753-6405.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study assessed the level of agreement, and predictors of agreement, between patient self-report and medical records for smoking status and alcohol consumption among patients attending one of four Aboriginal Community Controlled Health Service (ACCHSs). METHODS A convenience sample of 110 ACCHS patients self-reported whether they were current smokers or currently consumed alcohol. ACCHS staff completed a medical record audit for corresponding items for each patient. The level of agreement was evaluated using the kappa statistic. Factors associated with levels of agreement were explored using logistic regression. RESULTS The level of agreement between self-report and medical records was strong for smoking status (kappa=0.85; 95%CI: 0.75-0.96) and moderate for alcohol consumption (kappa=0.74; 95%CI: 0.60-0.88). None of the variables explored were significantly associated with levels of agreement for smoking status or alcohol consumption. CONCLUSIONS Medical records showed good agreement with patient self-report for smoking and alcohol status and are a reliable means of identifying potentially at-risk ACCHS patients. Implications for public health: ACCHS medical records are accurate for identifying smoking and alcohol risk factors for their patients. However, strategies to increase documentation and reduce missing data in the medical records are needed.
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Affiliation(s)
- Natasha Noble
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Louise Maher
- Centre for Epidemiology and Evidence, NSW Ministry of Health, New South Wales
| | - Daniel Jackman
- Maari Ma Health Aboriginal Corporation, New South Wales.,Outback Division of General Practice, New South Wales
| | - Billie Bonevski
- Hunter Medical Research Institute, New South Wales.,School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Anthony Shakeshaft
- School of Medicine and Public Health, University of Newcastle, New South Wales.,National Drug and Alcohol Research Centre, University of NSW Sydney, New South Wales
| | - Christine Paul
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
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