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

Journal article

Rombouts, Susan A., Conigrave, James H., Saitz, Richard, Louie, Eva, Haber, Paul and Morley, Kirsten C.. (2020). Evidence based models of care for the treatment of alcohol use disorder in primary health care settings : A systematic review. BMC Primary Care. 21(1), p. Article 260. https://doi.org/10.1186/s12875-020-01288-6
AuthorsRombouts, Susan A., Conigrave, James H., Saitz, Richard, Louie, Eva, Haber, Paul and Morley, Kirsten C.
Abstract

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.

Keywordsalcohol use disorder; treatment; primary health care; general practice; pharmacotherapy
Year2020
JournalBMC Primary Care
Journal citation21 (1), p. Article 260
PublisherBioMed Central
ISSN1471-2296
Digital Object Identifier (DOI)https://doi.org/10.1186/s12875-020-01288-6
PubMed ID33278891
Scopus EID2-s2.0-85097192314
PubMed Central IDPMC7719241
Open accessPublished as ‘gold’ (paid) open access
Page range1-17
FunderMinistry of Health, New South Wales
National Health and Medical Research Council (NHMRC)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online05 Dec 2020
Publication process dates
Accepted15 Oct 2020
Deposited28 Jul 2023
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