scholarly journals Managing Alcohol Use Disorder in Primary Health Care

2017 ◽  
Vol 19 (11) ◽  
Author(s):  
Peter Anderson ◽  
Amy O’Donnell ◽  
Eileen Kaner
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Primary Health

scholarly journals Evidence-based models of care for the treatment of alcohol use disorder in primary health care settings: protocol for systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Susan A. Rombouts ◽  
James Conigrave ◽  
Eva Louie ◽  
Paul Haber ◽  
Kirsten C. Morley
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Critical Appraisal ◽  
Models Of Care ◽  
Health Care Settings ◽  
Primary Health ◽  
Primary Health Care Settings

Abstract Background Alcohol use disorder (AUD) is highly prevalent and accounts globally for 1.6% of disability-adjusted life years (DALYs) among females and 6.0% of DALYs among males. Effective treatments for AUDs are available but are not commonly practiced in primary health care. Furthermore, referral to specialized care is often not successful and patients that do seek treatment are likely to have developed more severe dependence. A more cost-efficient health care model is to treat less severe AUD in a primary care setting before the onset of greater dependence severity. Few models of care for the management of AUD in primary health care have been developed and with limited implementation. This proposed systematic review will synthesize and evaluate differential models of care for the management of AUD in primary health care settings. Methods We will conduct a systematic review to synthesize studies that evaluate the effectiveness of models of care in the treatment of AUD in primary health care. A comprehensive search approach will be conducted using the following databases; MEDLINE (1946 to present), PsycINFO (1806 to present), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) (1991 to present), and Embase (1947 to present). Reference searches of relevant reviews and articles will be conducted. Similarly, a gray literature search will be done with the help of Google and the gray matter tool which is a checklist of health-related sites organized by topic. Two researchers will independently review all titles and abstracts followed by full-text review for inclusion. The planned method of extracting data from articles and the critical appraisal will also be done in duplicate. For the critical appraisal, the Cochrane risk of bias tool 2.0 will be used. Discussion This systematic review and meta-analysis aims to guide improvement of design and implementation of evidence-based models of care for the treatment of alcohol use disorder in primary health care settings. The evidence will define which models are most promising and will guide further research. Protocol registration number PROSPERO CRD42019120293.

scholarly journals Scaling-up primary health care-based prevention and management of alcohol use disorder at the municipal level in middle-income countries in Latin America: Background and pre-protocol for a three-country quasi-experimental study

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 311 ◽  
Author(s):  
Peter Anderson ◽  
Amy O'Donnell ◽  
Eileen Kaner ◽  
Antoni Gual ◽  
Bernd Schulte ◽  
...  
Keyword(s):  
Health Care ◽  
Experimental Study ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Heavy Drinking ◽  
Routine Practice ◽  
Primary Health ◽  
Implementation Period ◽  
Quasi Experimental

Background: While primary health care (PHC)-based prevention and management of alcohol use disorder (AUD) is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of AUD, operationalized by heavy drinking, in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment.

scholarly journals Scaling-up primary health care-based prevention and management of alcohol use disorder at the municipal level in middle-income countries in Latin America: Background and pre-protocol for a three-country quasi-experimental study

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 311 ◽  
Author(s):  
Peter Anderson ◽  
Amy O'Donnell ◽  
Eileen Kaner ◽  
Antoni Gual ◽  
Bernd Schulte ◽  
...  
Keyword(s):  
Health Care ◽  
Experimental Study ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Heavy Drinking ◽  
Routine Practice ◽  
Primary Health ◽  
Implementation Period ◽  
Quasi Experimental

Background: While primary health care (PHC)-based prevention and management of alcohol use disorder (AUD) is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of AUD, operationalized by heavy drinking, in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment.

Russian-language mobile applications for reducing alcohol use: a systematic search and evaluation. (Preprint)

2021 ◽  
Author(s):  
Anna Bunova ◽  
Veronika Wiemker ◽  
Boris Gornyi ◽  
Carina Ferreira-Borges ◽  
Maria Neufeld
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Mobile Applications ◽  
Russian Language ◽  
Brief Interventions ◽  
Bibliographic Databases ◽  
Lifestyle Behavior ◽  
Primary Health

BACKGROUND Personalized prevention tools, such as mobile applications designed to reduce alcohol consumption, are widespread in mobile application stores accessible in Russia. However, their quality and content have not been systematically evaluated. OBJECTIVE This study aimed to identify Russian-language mobile applications for reducing alcohol use and evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify applications that could facilitate screening and brief interventions in primary health care in Russia. METHODS A systematic search for mobile applications available in Russia was carried out between April 1 and 15, December 1 and 15, 2020, and in March 2021 in the iOS App Store, Google Play Store, and the 4PDA forum. Application quality was assessed via the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases used to evaluate the applications’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS). RESULTS We identified a total of 63 mobile applications for reducing alcohol use. Mean MARS quality ratings were high for the subscales of “Functionality” (3.92 out of 5, SD = 0.58) and “Aesthetics” (2.96; SD = 0.76) and low for “Engagement” (2.42; SD = 0.76) and “Information” (1.65, SD = 0.60). Additional searches in electronic libraries and bibliographic databases (Elibrary, Cyberleninka, Google Scholar) yielded no studies involving the identified applications. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD = 3.24). Two of the identified applications might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing. CONCLUSIONS Russian-language mobile applications for reducing alcohol use are accessible in the application stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about scientific trialing or testing is lacking. Most applications contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile applications for reducing alcohol use. Our findings underline the need to develop evidence-based applications to mitigate alcohol consumption in Russia and elsewhere. CLINICALTRIAL PROSPERO (CRD42020167458) (review ongoing).

High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa

2016 ◽  
Vol 28 (7) ◽  
pp. 651-659 ◽  
Author(s):  
Diana Huis in ‘t Veld ◽  
Supa Pengpid ◽  
Robert Colebunders ◽  
Linda Skaal ◽  
Karl Peltzer
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Alcohol Use ◽  
Hiv Infection ◽  
Psychosocial Factors ◽  
Low Risk ◽  
Health Care Clinics ◽  
Primary Health

Alcohol use may have a negative impact on the course of HIV disease and the effectiveness of its treatment. We studied patients with HIV who use alcohol and associated socio-demographic, health and psychosocial factors. Outcomes from this study may help in selecting patients from clinical practice with high-risk alcohol use and who are likely to benefit most from alcohol reduction interventions. In a cross sectional study in three primary health care clinics in Pretoria, South Africa, from January 2012 to June 2012, patients with HIV infection were interviewed and patients’ medical files were reviewed to obtain data on levels of alcohol use (Alcohol Use Disorder Identification Test), patients’ socio-demographic characteristics, HIV-related information, health related quality of life (WHOQoL-HIVBref), internalized AIDS stigma, symptoms of depression and adherence to antiretroviral therapy. Analyses consisted of descriptive statistics, bi- and multivariate logistic regression models. A total of 2230 patients (1483 [66.5%] female) were included. The median age was 37 years (interquartile range 31–43), 99.5% were black Africans, 1975 (88.6%) had started ART and the median time on ART was 22 months (interquartile range 9–40). No alcohol was used by 64% of patients, 8.9% were low risk drinkers, 25.1% of patients were hazardous or harmful drinkers and 2.0% had possible alcohol dependence. In multivariate analysis high-risk drinking was positively associated with male gender, never being married, tobacco use, a higher score for the ‘level of independence’-domain measured with the WHOQoL-HIVBref questionnaire, and with more depressive symptoms compared to low-risk drinking. This study shows a high prevalence of hazardous or harmful drinking in patients with HIV infection (especially men) attending primary health care clinics in South Africa. Routine screening for alcohol use should be introduced in these clinics and harm reduction interventions should be evaluated, taking into account associated factors.

scholarly journals Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0216199 ◽  
Author(s):  
Esperanza Romero-Rodríguez ◽  
Luis Ángel Pérula de Torres ◽  
Fernando Leiva-Cepas ◽  
José Ángel Fernández García ◽  
Sara Fernández López ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Health Care Professionals ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Preventive Practices ◽  
Primary Health

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

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Susan A. Rombouts ◽  
James H. Conigrave ◽  
Richard Saitz ◽  
Eva Louie ◽  
Paul Haber ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Models Of Care ◽  
Health Care Settings ◽  
Treatment Uptake ◽  
Primary Health ◽  
Intensity Of Care ◽  
Primary Health Care Settings

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.

scholarly journals Effectiveness of brief group intervention in the harmful alcohol use in primary health care

2019 ◽  
Vol 53 ◽  
pp. 4 ◽  
Author(s):  
Janaina Soares ◽  
Divane De Vargas
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Alcohol Use ◽  
Group Intervention ◽  
Control Group ◽  
Primary Health ◽  
Harmful Alcohol ◽  
Experimental Group ◽  
Hazardous Use

OBJECTIVE: To verify the effectiveness of brief group intervention, performed by nurses, in reducing the hazardous or harmful alcohol use in users of a primary health care service. METHODS: Clinical and randomized trial with follow-up of three months. The sample had 180 individuals with a pattern of hazardous or harmful alcohol use, recruited in a Basic Health Unit in the city of São Paulo. A sociodemographic questionnaire and the Alcohol Use Disorders Identification Test (Audit) were applied. The experimental group underwent the Brief Group Intervention, which had four group sessions, with weekly meetings. The control group received an information leaflet about issues related to alcohol consumption. Both groups participated in the follow-up of three months. The linear mixed model was used for data analysis, in which a 5% significance level was adopted. RESULTS: Forty-four individuals under hazardous or harmful alcohol use completed all phases of the research. The experimental group had a statistically significant reduction (p ≤ 0.01) of about 10 points in Audit score after the brief group intervention [before BGI = 15.89 (SD = 6.62) – hazardous use; after BGI = 6.40 (SD = 5.05) – low hazardous use] maintaining the low hazardous use in follow-up [6.69 (SD = 6.38) – low hazardous use]. The control group had a statistically significant reduction (p ≤ 0.01) of about three points in Audit score [before BGI = 13.11 (SD = 4.54) – hazardous use; after BGI = 9.83 (SD = 5.54) – hazardous use] and in follow-up presented the mean score of 13.00 (SD = 5.70), indicative of hazardous use. Differences between the two groups (experimental group versus control group) in reduction of consumption were statistically significant (p ≤ 0.01). CONCLUSIONS: Our evidence showed that the brief group intervention performed by the nurse in the primary health care context was effective to reduce alcohol consumption in individuals with patterns of hazardous or harmful use.

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