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
Permalink -

https://acuresearchbank.acu.edu.au/item/8z68v/evidence-based-models-of-care-for-the-treatment-of-alcohol-use-disorder-in-primary-health-care-settings-a-systematic-review

Log in to edit

Download files

Publisher's version
OA_Rombouts_2020_Evidence_based_models_of_care_for.pdf
License: CC BY 4.0
File access level: Open

  • 93
    total views
  • 38
    total downloads
  • 6
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Alcohol screening in 22 Australian Aboriginal Community Controlled Health Organisations : Clinical context and who is screened
Weatherall, Teagan J., Conigrave, James, Lee, K. S. Kylie, Vnuk, Julia, Ivers, Rowena, Hayman, Noel, Wilson, Scott, Gray, Dennis and Conigrave, Kate. (2024). Alcohol screening in 22 Australian Aboriginal Community Controlled Health Organisations : Clinical context and who is screened. Drug and Alcohol Review. 43(5), pp. 1226-1234. https://doi.org/10.1111/dar.13851
Low rates of prescribing alcohol relapse prevention medicines in Australian Aboriginal Community Controlled Health Services
Purcell-Khodr, Gemma C., Conigrave, James, Lee, K. S. Kylie, Vnuk, Julia and Conigrave, Kate. (2023). Low rates of prescribing alcohol relapse prevention medicines in Australian Aboriginal Community Controlled Health Services. Drug and Alcohol Review. 42(7), pp. 1606-1616. https://doi.org/10.1111/dar.13708
Central markers of neuroinflammation in alcohol use disorder : A meta-analysis of neuroimaging, cerebral spinal fluid, and postmortem studies
Adams, Claire, Perry, Nina, Conigrave, James, Hurzeler, Tristan, Stevens, Julia, Yacou Dunbar, Kristiane P., Sweeney, Alicia, Lee, K. S. Kylie, Sutherland, Greg, Haber, Paul and Morley, Kirsten C.. (2023). Central markers of neuroinflammation in alcohol use disorder : A meta-analysis of neuroimaging, cerebral spinal fluid, and postmortem studies. Alcoholism : Clinical and Experimental Research. 47(2), pp. 197-208. https://doi.org/10.1111/acer.14992
Trajectories of Psychological Distress of Men Treated at Aboriginal Residential Rehabilitation Services for Alcohol and Drug Misuse
Chambers, Mark S., Shakeshaft, Anthony, Mills, Llewellyn, Clifford-Motopi, Anton, Conigrave, James, James, Doug B. and Tran, Anh Dam. (2023). Trajectories of Psychological Distress of Men Treated at Aboriginal Residential Rehabilitation Services for Alcohol and Drug Misuse. International Journal of Mental Health and Addiction. pp. 1-19. https://doi.org/10.1007/s11469-023-01217-5
Unintended consequences : Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns
Conigrave, James, Devine, Emma K., Lee, K. S. Kylie, Dobbins, Timothy, Vnuk, Julia, Hayman, Noel and Conigrave, Kate. (2023). Unintended consequences : Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns. Drug and Alcohol Review. 42(7), pp. 1633-1638. https://doi.org/10.1111/dar.13761
An umbrella review of the benefits and risks associated with youths’ interactions with electronic screens
Sanders, Taren Grant, Noetel, Michael, Parker, Philip David, del Pozo Cruz, Borja, Biddle, Stuart, Ronto, Rimante, Hulteen, Ryan, Parker, Rhiannon B., Thomas, George, De Cocker, Katrien, Salmon, Jo, Hesketh, Kylie, Weeks, Nicole, Arnott, Hugh, Devine, Emma K., Pires Vasconcellos, Roberta, Pagano, Rebecca Stella, Sherson, Jamie, Conigrave, James and Lonsdale, Christopher Sean. (2023). An umbrella review of the benefits and risks associated with youths’ interactions with electronic screens. Nature Human Behaviour. pp. 1-21. https://doi.org/10.1038/s41562-023-01712-8
A meta-analysis of the dark side of the American dream : Evidence for the universal wellness costs of prioritizing extrinsic over intrinsic goals
Bradshaw, Emma L., Conigrave, James H., Steward, Ben A., Ferber, Kelly A., Parker, Philip D. and Ryan, Richard M.. (2023). A meta-analysis of the dark side of the American dream : Evidence for the universal wellness costs of prioritizing extrinsic over intrinsic goals. Journal of Personality and Social Psychology. 124(4), pp. 873-899. https://doi.org/10.1037/pspp0000431
‘The Drug Survey App’ : A protocol for developing and validating an interactive population survey tool for drug use among Aboriginal and Torres Strait Islander Australians
Conigrave, James H., Wilson, Scott, Conigrave, Katherine M., Chikritzhs, Tanya, Hayman, Noel, Dawson, Angela, Ali, Robert, Perry, Jimmy, Fitts, Michelle S., Degenhardt, Louisa, Doyle, Michael, Egert, Sonya, Slade, Tim, Ezard, Nadine, Dzidowska, Monika and Lee, K. S. Kylie. (2022). ‘The Drug Survey App’ : A protocol for developing and validating an interactive population survey tool for drug use among Aboriginal and Torres Strait Islander Australians. Addiction Science and Clinical Practice. 17(1), p. Article 17. https://doi.org/10.1186/s13722-022-00298-2
Support for Aboriginal health services in reducing harms from alcohol : 2-year service provision outcomes in a cluster randomized trial
Dzidowska, Monika, Lee, K. S. Kylie, Conigrave, James H., Dobbins, Timothy A., Hummerston, Beth, Wilson, Scott, Haber, Paul S., Gray, Dennis and Conigrave, Katherine M.. (2022). Support for Aboriginal health services in reducing harms from alcohol : 2-year service provision outcomes in a cluster randomized trial. Addiction. 117(3), pp. 796-803. https://doi.org/10.1111/add.15712
Indigenous Australian drinking risk : Comparing risk categorisations based on recall of recent drinking occasions to AUDIT-C screening in a representative sample
Conigrave, James H., Conigrave, Katherine M., Wilson, Scott and Lee, K. S. Kylie. (2022). Indigenous Australian drinking risk : Comparing risk categorisations based on recall of recent drinking occasions to AUDIT-C screening in a representative sample. Drug and Alcohol Review. 41(3), pp. 616-624. https://doi.org/10.1111/dar.13403
Prevalence and correlates of alcohol dependence in an Australian Aboriginal and Torres Strait Islander representative sample : Using the Grog Survey App
Weatherall, Teagan J., Conigrave, James H., Conigrave, Katherine M., Perry, Jimmy, Wilson, Scott, Room, Robin, Fitts, Michelle S., Hayman, Noel and Lee, K. S. Kylie. (2022). Prevalence and correlates of alcohol dependence in an Australian Aboriginal and Torres Strait Islander representative sample : Using the Grog Survey App. Drug and Alcohol Review. 41(1), pp. 125-134. https://doi.org/10.1111/dar.13292
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
Conigrave, James, Lee, K. S. Kylie, Haber, Paul, Vnuk, Julia, Doyle, Michael and Conigrave, Kate. (2022). 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. Addiction Science and Clinical Practice. 17(1), p. Article 23. https://doi.org/10.1186/s13722-022-00306-5
Predictors of length of treatment, discharge reason, and re-admission to Aboriginal alcohol and other drug residential rehabilitation services in New South Wales, Australia
James, Doug B., Lee, K. S. Kylie, Dronavalli, Mithilesh, Courtney, Ryan J., Conigrave, Katherine M., Conigrave, James H. and Shakeshaft, Anthony. (2022). 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 and Alcohol Review. 41(3), pp. 603-615. https://doi.org/10.1111/dar.13388
Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App : A representative urban and remote sample
Zheng, Catherine, Conigrave, James, Conigrave, Kate, Wilson, Scott, Perry, Jimmy, Chikritzhs, Tanya, Fitts, Michelle S. and Lee, K. S. Kylie. (2022). Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App : A representative urban and remote sample. Drug and Alcohol Review. 41(1), pp. 114-124. https://doi.org/10.1111/dar.13333
Support can increase use of the AUDIT-C in Australian Aboriginal Community Controlled Health Services : A cluster randomized trial
Conigrave, James H., Harrison, Kristie H., Lee, K. S. Kylie, Dobbins, Timothy A., Hummerston, Beth, Hayman, Noel, Perry, Jimmy, Ivers, Rowena, Haber, Paul S., Wilson, Scott, Johnson, David and Conigrave, Katherine M.. (2021). Support can increase use of the AUDIT-C in Australian Aboriginal Community Controlled Health Services : A cluster randomized trial. Addiction. 116(9), pp. 2304-2315. https://doi.org/10.1111/add.15428
A multi-methods yarn about SMART Recovery : First insights from Australian Aboriginal facilitators and group members
Dale, Elizabeth, Lee, K. S. Kylie, Conigrave, Katherine M., Conigrave, James H., Ivers, Rowena, Clapham, Kathleen and Kelly, Peter J.. (2021). A multi-methods yarn about SMART Recovery : First insights from Australian Aboriginal facilitators and group members. Drug and Alcohol Review. 40(6), pp. 1013-1027. https://doi.org/10.1111/dar.13264
Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians : Harms, getting help and awareness of local treatments
Weatherall, Teagan J., Conigrave, James H., Conigrave, Katherine M., Perry, Jimmy, Wilson, Scott, Room, Robin, Chikritzhs, Tanya and Kylie Lee, K. S.. (2021). Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians : Harms, getting help and awareness of local treatments. Addiction Science and Clinical Practice. 16(1), p. Article 65. https://doi.org/10.1186/s13722-021-00274-2
Acceptability and feasibility of a computer-based application to help Aboriginal and Torres Strait Islander Australians describe their alcohol consumption
Lee, K. S. Kylie, Conigrave, James H., Al Ansari, Mustafa, Wilson, Scott, Perry, Jimmy, Zheng, Catherine, Freeburn, Bradley, Room, Robin, Callinan, Sarah, Hayman, Noel, Chikritzhs, Tanya, Slade, Tim, Gray, Dennis and Conigrave, Kate. (2021). Acceptability and feasibility of a computer-based application to help Aboriginal and Torres Strait Islander Australians describe their alcohol consumption. Journal of Ethnicity in Substance Abuse. 20(1), pp. 16-33. https://doi.org/10.1080/15332640.2019.1579144
Recruiting a representative sample of urban South Australian Aboriginal adults for a survey on alcohol consumption
Lee, K. S. Kylie, Fitts, Michelle S., Conigrave, James H., Zheng, Catherine, Perry, Jimmy, Wilson, Scott, Ah Chee, Dudley, Bond, Shane, Weetra, Keith, Chikritzhs, Tanya N., Slade, Tim and Conigrave, Katherine M.. (2020). Recruiting a representative sample of urban South Australian Aboriginal adults for a survey on alcohol consumption. BMC Medical Research Methodology. 20(1), p. Article 183. https://doi.org/10.1186/s12874-020-01067-y
A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care : A role for continuous quality improvement
Dzidowska, Monika, Lee, K. S. Kylie, Wylie, Claire, Bailie, Jodie, Percival, Nikki, Conigrave, James H., Hayman, Noel and Conigrave, Katherine M.. (2020). A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care : A role for continuous quality improvement. BMC Primary Care. 21(1), p. Article 33. https://doi.org/10.1186/s12875-020-1101-x
What is the prevalence of current alcohol dependence and how is it measured for Indigenous people in Australia, New Zealand, Canada and the United States of America? A systematic review
Weatherall, Teagan J., Conigrave, Katherine M., Conigrave, James H. and Lee, K. S. Kylie. (2020). What is the prevalence of current alcohol dependence and how is it measured for Indigenous people in Australia, New Zealand, Canada and the United States of America? A systematic review. Addiction Science and Clinical Practice. 15(1), p. Article 32. https://doi.org/10.1186/s13722-020-00205-7
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, Gemma C., Lee, K. S. Kylie, Conigrave, James H., Webster, Emma and Conigrave, Katherine M.. (2020). What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review : Australia, New Zealand, USA and Canada. Addiction Science and Clinical Practice. 15(1), p. Article 31. https://doi.org/10.1186/s13722-020-00204-8
Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples : A meta-analysis to identify sources of heterogeneity
Conigrave, James H., Lee, K. S. Kylie, Zheng, Catherine, Wilson, Scott, Perry, Jimmy, Chikritzhs, Tanya, Slade, Tim, Morley, Kirsten, Room, Robin, Callinan, Sarah, Hayman, Noel and Conigrave, Katherine M.. (2020). Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples : A meta-analysis to identify sources of heterogeneity. Addiction. 115(10), pp. 1817-1830. https://doi.org/10.1111/add.15015
Alcohol use disorder and circulating cytokines : A systematic review and meta-analysis
Adams, Claire, Conigrave, James H., Lewohl, Joanne, Haber, Paul and Morley, Kirsten C.. (2020). Alcohol use disorder and circulating cytokines : A systematic review and meta-analysis. Brain, Behavior, and Immunity. 89, pp. 501-512. https://doi.org/10.1016/j.bbi.2020.08.002
Supporting Aboriginal Community Controlled Health Services to deliver alcohol care : Protocol for a cluster randomised controlled trial
Harrison, Kristie H., Lee, K. S. Kylie, Dobbins, Timothy, Wilson, Scott, Hayman, Noel, Ivers, Rowena, Haber, Paul S., Conigrave, James H., Johnson, David, Hummerston, Beth, Gray, Dennis and Conigrave, Katherine. (2019). Supporting Aboriginal Community Controlled Health Services to deliver alcohol care : Protocol for a cluster randomised controlled trial. BMJ Open. 9(11), p. Article e030909. https://doi.org/10.1136/bmjopen-2019-030909
Evidence-based models of care for the treatment of alcohol use disorder in primary health care settings : Protocol for systematic review
Rombouts, Susan A., Conigrave, James, Louie, Eva, Haber, Paul and Morley, Kirsten C.. (2019). Evidence-based models of care for the treatment of alcohol use disorder in primary health care settings : Protocol for systematic review. Systematic Reviews. 8(1), p. Article 275. https://doi.org/10.1186/s13643-019-1157-7
Systematic review of addiction recovery mutual support groups and Indigenous people of Australia, New Zealand, Canada, the United States of America and Hawaii
Dale, Elizabeth, Kelly, Peter J., Lee, K. S. Kylie, Conigrave, James H., Ivers, Rowena and Clapham, Kathleen. (2019). Systematic review of addiction recovery mutual support groups and Indigenous people of Australia, New Zealand, Canada, the United States of America and Hawaii. Addictive Behaviors. 98, p. Article 106038. https://doi.org/10.1016/j.addbeh.2019.106038
Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App : A stratified sample
Lee, K. S. Kylie, Conigrave, James H., Wilson, Scott, Perry, Jimmy, Hayman, Noel, Zheng, Catherine, Al Ansari, Mustafa, Doyle, Michael, Room, Robin, Callinan, Sarah, Chikritzhs, Tanya, Slade, Tim and Conigrave, Katherine M.. (2019). Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App : A stratified sample. BMC Medical Informatics & Decision Making. 19(1), p. Article 180. https://doi.org/10.1186/s12911-019-0879-8
Short screening tools for risky drinking in Aboriginal and Torres Strait Islander Australians : Modified AUDIT-C and a new approach
Lee, K. S. Kylie, Conigrave, James H., Wilson, Scott, Perry, Jimmy, Callinan, Sarah, Room, Robin, Chikritzhs, Tanya N., Slade, Tim, Hayman, Noel, Leggat, Geoffrey and Conigrave, Katherine M.. (2019). Short screening tools for risky drinking in Aboriginal and Torres Strait Islander Australians : Modified AUDIT-C and a new approach. Addiction Science and Clinical Practice. 14(1), p. Article 22. https://doi.org/10.1186/s13722-019-0152-6
Asking about the last four drinking occasions on a tablet computer as a way to record alcohol consumption in Aboriginal and Torres Strait Islander Australians: a validation
Lee, K. S. Kylie, Conigrave, James H., Callinan, Sarah, Wilson, Scott, Room, Robin, Perry, Jimmy, Slade, Tim, Chikritzhs, Tanya N., Hayman, Noel, Weatherall, Teagan, Leggat, Geoffrey, Gray, Dennis and Conigrave, Katherine M.. (2019). Asking about the last four drinking occasions on a tablet computer as a way to record alcohol consumption in Aboriginal and Torres Strait Islander Australians: a validation. Addiction Science and Clinical Practice. 14(1), p. Article 15. https://doi.org/10.1186/s13722-019-0148-2