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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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Ong CB, Puri S, Lebowitz J, Chiu YF, Della Valle AG, Sideris A, Chalmers BP. Preoperative cannabis use does not increase opioid utilization following primary total hip arthroplasty in a propensity matched analysis. Arch Orthop Trauma Surg 2022; 143:3629-3635. [PMID: 36129515 DOI: 10.1007/s00402-022-04619-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE The recreational and medical use of cannabis is being legalized worldwide. Its use has been linked to an increased risk of developing opioid use disorders. As opioids continue to be prescribed after total hip arthroplasty (THA), the influence that preoperative cannabis use may have on postoperative opioid consumption remains unknown. The purpose of this study was to assess the relationship between preoperative cannabis use and opioid utilization following primary THA. METHODS We identified all patients over the age of 18 who underwent unilateral, primary THA for a diagnosis of osteoarthritis at a single institution from February 2019 to April 2021. Our cohort was grouped into current cannabis users (within 6 months of surgery) and those who reported never using cannabis. One hundred and fifty-six current users were propensity score matched 1:6 with 936 never users based on age, sex, BMI, history of chronic pain, smoking status, history of anxiety/depression, ASA classification and type of anesthesia. Outcomes included inpatient and postdischarge opioid use in morphine milligram equivalents. RESULTS Total inpatient opioid utilization, opioids refilled, and total opioids used within 90 postoperative days were similar between the groups. CONCLUSION In propensity score matched analyses, preoperative cannabis use was not independently associated with an increase in inpatient or outpatient, 90-days opioid consumption following elective THA.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Juliana Lebowitz
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yu-Fen Chiu
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | | | - Alexandra Sideris
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Brian P Chalmers
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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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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