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

Journal article

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
AuthorsDzidowska, Monika, Lee, K. S. Kylie, Wylie, Claire, Bailie, Jodie, Percival, Nikki, Conigrave, James H., Hayman, Noel and Conigrave, Katherine M.
Abstract

Background
Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements.

Methods
We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes.

Results
Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements.

Conclusion
Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).

Keywordsalcohol; unhealthy alcohol use; alcohol use disorders; implementation; primary health care; continuous quality improvement; screening; treatment; brief intervention
Year2020
JournalBMC Primary Care
Journal citation21 (1), p. Article 33
PublisherBioMed Central
ISSN1471-2296
Digital Object Identifier (DOI)https://doi.org/10.1186/s12875-020-1101-x
PubMed ID32054450
Scopus EID2-s2.0-85079338332
PubMed Central IDPMC7020510
Open accessPublished as ‘gold’ (paid) open access
Page range1-22
FunderNational Health and Medical Research Council (NHMRC)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online13 Feb 2020
Publication process dates
Accepted29 Jan 2020
Deposited28 Jul 2023
Grant ID105339
1117582
Permalink -

https://acuresearchbank.acu.edu.au/item/8z68w/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

Log in to edit

Download files

Publisher's version
OA_Dzidowska_2020_A_systematic_review_of_approaches_to.pdf
License: CC BY 4.0
File access level: Open

  • 20
    total views
  • 10
    total downloads
  • 0
    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

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