Reducing alcohol-related harm in Australia: a simple data-based tool to assist prioritization of research and health care delivery in primary care

2018 ◽  
Vol 36 (4) ◽  
pp. 473-478
Author(s):  
Megan Freund ◽  
Breanne Hobden ◽  
Simon Deeming ◽  
Natasha Noble ◽  
Jamie Bryant ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Alcohol Use ◽  
Simple Method ◽  
Harmful Alcohol ◽  
Hypothetical Scenario ◽  
Brief Advice ◽  
Alcohol Related Harm ◽  
Related Harm

Abstract Introduction The detection of harmful alcohol use and the delivery of brief advice in primary care are less than optimal. Given limited health care resources, deciding where best to allocate funding to optimize health outcomes is imperative. A simple data-based tool could be useful when access to specialist health economic advice is unavailable. This study aimed to examine the utility of a simple data-based calculator to facilitate priority setting in general practice for reducing alcohol-related harm. Methods A simple algorithm was developed within Microsoft Excel to allow comparison of hypothetical intervention scenarios that aimed to increase detection and brief advice for harmful alcohol use in general practice. The calculator accommodated varying implementation costs, size of effect and reach for each scenario created. The incremental costs of the intervention scenarios, the incremental number of successes (i.e. abstinence or drinking at safe levels) and the incremental costs-effectiveness ratio (ICER) were calculated for each hypothetical scenario and compared with a usual care scenario. Results In the hypothetical scenarios modelled, increasing both the detection of harmful alcohol consumption and the provision of brief advice produced the greatest number of incremental successes above baseline. Increasing detection alone produced fewer incremental successes but was the most cost-effective approach, as indicated by the lowest ICER. Discussion The data-based calculator provides a simple method of exploring reach and cost-effectiveness outcomes without the need for any specific skills. Although this approach has limitations, the calculator can be used by decision makers to guide intervention planning.

Prevention approaches to reduce alcohol-related harm

2018 ◽  
pp. 317-326
Author(s):  
William Gilmore ◽  
Katherine Brown ◽  
Ian Gilmore
Keyword(s):  
Alcohol Use ◽  
Secondary Prevention ◽  
Mental Health Problems ◽  
Economic Effects ◽  
Fetal Alcohol ◽  
Self Harm ◽  
Brief Advice ◽  
Alcohol Related Harm ◽  
Fetal Alcohol Spectrum ◽  
Related Harm

The health, social, and economic effects of alcohol use are experienced by drinkers, families, communities, and society at large. Alcohol use is inextricably linked to a range of mental health problems. It may be the primary problem or part of the co-morbidities that accompany so much mental illness. Alcohol use is also associated with many other health conditions, including liver disease, cardiovascular disease and cancer, and is strongly linked to violence, accidents, self-harm, suicide, and fetal alcohol spectrum disorder. This chapter outlines both primary and secondary prevention approaches to reduce alcohol-related harm that are evidence-based. Primary prevention approaches include regulating alcohol affordability, availability, and promotion, and providing information and education. Secondary prevention approaches include early identification and brief advice.

scholarly journals Exploring the use of workplaces to recruit “hard-to-reach” male drinkers to a survey on alcohol use and awareness of health messages

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Dance ◽  
Charlotte Dack ◽  
Celia Lasheras ◽  
Cathy McMahon ◽  
Paul Scott ◽  
...  
Keyword(s):  
Public Health ◽  
Alcohol Use ◽  
Financial Incentive ◽  
Health Messages ◽  
Heavy Episodic Drinking ◽  
Future Research ◽  
Recruitment Strategies ◽  
Public Health Messages ◽  
Alcohol Related Harm ◽  
Related Harm

Abstract Background Lower socioeconomic status (SES) groups, particularly lower SES males, are at greater risk of alcohol-related harm than higher SES groups, despite drinking at the same level or less. However, they are rarely recruited for research through typical recruitment strategies. Consequently, limited evidence exists on patterns of alcohol use and effectiveness of public health messages for these groups. Using workplaces to recruit male drinkers from lower SES backgrounds may provide a feasible and accessible approach to research participation and enable improved understanding of alcohol use, drinking motives and acceptance of alcohol-related public health messages in this underrepresented and high-risk group. We investigated workplace-based strategies to recruit male drinkers from lower SES backgrounds. We also investigated their experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages. Methods A feasibility element investigated the effectiveness of workplace-based strategies to recruit male drinkers from lower SES backgrounds in the south west of England. A pilot element investigated this population’s experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages, through a mixed-methods survey. Results Feasibility results indicated that workplace-based recruitment strategies, including recruiting participants in person at their workplace and providing a financial incentive, effectively led to the recruitment of 84 male drinkers (70% recruitment rate), predominately from lower SES backgrounds, to a survey. Pilot results indicated that more than half of participants were at increasing risk of alcohol-related harm, and approximately one fifth engaged in weekly heavy episodic drinking. Participation in campaigns aimed at reducing alcohol use, and knowledge of government alcohol consumption guidelines, were low. Participants reported negative beliefs about alcohol including health effects, dependency and excess use, and financial and occupational effects. Positive beliefs about alcohol included relaxation, socialising, and enjoyment. Conclusions Workplace-based recruitment, using in-person recruitment and a financial incentive, may be a feasible strategy to recruit male drinkers from lower SES backgrounds. Pilot results may direct larger scale research aiming to understand alcohol use in this population and inform targeted public health messages. Workplace-based recruitment may represent a promising avenue for future research aiming to tackle inequalities in participation in alcohol research.

Community Health and General Practice: The Impact of Different Cultures on the Integration of Primary Care

2001 ◽  
Vol 7 (1) ◽  
pp. 65 ◽  
Author(s):  
Hal Swerissen ◽  
Jenny Macmillan ◽  
Catuscia Biuso ◽  
Linda Tilgner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Centres ◽  
Care Services ◽  
Primary Health ◽  
Health Centres ◽  
The Relationship

This study examined the existing relationship between community health centres and General Practice Divisions in the State of Victoria, including the nature of joint working arrangements and the identification of barriers to greater collaboration. Improved integration of primary health care services has been advocated to improve consumer and population health outcomes and to reduce inappropriate use of acute and extended care services. General practitioners (GPs) and community health centres are two key providers of primary health care with potential for greater integration. The current study conducted telephone interviews with 20 community health centre CEOs and 18 Executive Officers of divisions, which were matched according to catchment boundaries. Results suggest, while some joint planning is occurring, especially on committees, working parties and projects, there is an overall low level of satisfaction with the relationship between community health centres and GPs and GP divisions. Major barriers to greater integration are the financial or business interests of GPs and misunderstanding and differences in perceived roles and ideology between GPs and community health centres. Improved communication, greater contact and referral and follow-up procedures are identified as a means of improving the relationship between GPs, GP divisions and community health centres. Community health centres and general practitioners (GPs) are key providers of primary care (Australian Community Health Association, 1990).

scholarly journals The Cochrane 2018 Review on Brief Interventions in Primary Care for Hazardous and Harmful Alcohol Consumption: A Distillation for Clinicians and Policy Makers

2019 ◽  
Vol 54 (4) ◽  
pp. 417-427 ◽  
Author(s):  
F R Beyer ◽  
F Campbell ◽  
N Bertholet ◽  
J B Daeppen ◽  
J B Saunders ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Alcohol Consumption ◽  
Brief Intervention ◽  
Emergency Care ◽  
Total Duration ◽  
Brief Interventions ◽  
Men And Women ◽  
Harmful Alcohol ◽  
The Impact

Abstract Aims An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Methods Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. Results We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference −20 g/wk, 95% confidence interval −28 to −12). Subgroup analysis showed a similar effect for men and women. Conclusions Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting.

scholarly journals Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomised trial

2020 ◽  
Author(s):  
Nicolas Barticevic ◽  
Fernando Poblete ◽  
Soledad Zuzulich ◽  
Victoria Rodriguez ◽  
Laura Bradshaw
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Usual Care ◽  
Alcohol Use Disorders ◽  
Randomised Trial ◽  
Intervention Group ◽  
Psychosocial Treatment ◽  
Motivational Enhancement Therapy ◽  
Harmful Alcohol ◽  
Use Pattern

Abstract Background : Harmful alcohol use is a leading cause of global disability and death. However increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. Methods : A parallel-group, single-blinded, severity-stratified, randomised clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfil DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomised to each treatment group. The intervention group will receive an adaptation of the Motivational Enhancement Therapy, as manualized in Project MATCH. This treatment consists of four 45-minute sessions provided by a general psychologist with at least three years of primary care experience. The primary outcome is the change from baseline in the Drinks per Drinking Day during the last 90 days, which will be captured using the TimeLine Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analysed according to the group they were allocated, regardless of the treatment actually received. Mean Differences (MD) will be computed for continuous outcomes and Relative Risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. Discussion : This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. Trial registration : ClinicalTrials.gov, NCT04345302, Registered 28 April 2020, https://clinicaltrials.gov/show/NCT04345302

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