Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, United Nations Road, P.O. Box 65001, Dar es Salaam, Tanzania.
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2024 Mar 27;24(1):385. doi: 10.1186/s12913-024-10687-9.
Ensuring that evidence-based interventions for people with alcohol use disorders (AUD) are acceptable, effective, and feasible in different socio-cultural and health system contexts is essential. We previously adapted a model of integration of AUD interventions for the Tanzanian primary healthcare system. This pilot study aimed to assess the impact on AUD detection and the acceptability and feasibility of the facility-based components of this model from the perspective of healthcare providers (HCPs).
This mixed-methods study comprised a pre-post quasi-experimental study and a qualitative study. The integrated model included training HCPs in managing AUD, introducing systematic screening for AUD, documentation of AUD service utilization, and supportive supervision. We collected information on the number of people identified for AUD three months before and after piloting the service model. A non-parametric trend test, a distribution-free cumulative sum test, was used to identify a change in the identification rate of AUD beyond that observed due to secular trends or, by chance, three months before and after implementing the integrated AUD facility-based interventions. The Mann-Kendal test was used to assess the statistical significance of the trend. We conducted three focus group discussions exploring the experience of HCPs and their perspectives on facilitators, barriers, and strategies to overcome them. The focus group discussions were analyzed using thematic analysis.
During the pre-implementation phase of the facility-based interventions of the adapted AUD model, HCPs assessed 322 people for AUD over three months, ranging from a minimum of 99 to a maximum of 122 per month. Of these, 77 were identified as having AUD. Moreover, HCPs screened 2058 people for AUD during implementation; a minimum of 528 to a maximum of 843 people were screened for AUD per month for the three months. Of these, 514 screened positive for AUD (AUDIT ≥ 8). However, this change in screening for AUD was not statistically significant (p-value = 0.06). HCPs reported that knowledge and skills from the training helped them identify and support people they would not usually consider having problematic alcohol use. Perceived barriers to implementation included insufficient health personnel compared to needs and inconvenient health management information systems. HCPs proposed strategies to overcome these factors and recommended multisectoral engagement beyond the health system.
Although the change in the trend in the number of people screened for AUD by HCPs post-implementation was not statistically significant, it is still feasible to implement the facility-based components of the adapted integrated AUD model while addressing the identified bottlenecks and strategies for implementation. Therefore, a large-scale, adequately powered implementation feasibility study is needed. Findings from this study will be used to finalize the adapted model for integrating AUD interventions for future implementation and larger-scale evaluation.
确保针对酒精使用障碍（AUD）患者的循证干预措施在不同的社会文化和卫生系统背景下是可接受、有效和可行的，这一点至关重要。我们之前对针对坦桑尼亚初级卫生保健系统的 AUD 干预措施整合模型进行了调整。本试点研究旨在从卫生保健提供者（HCP）的角度评估该模型的基于设施的组成部分对 AUD 检测的影响，以及其可接受性和可行性。
这项混合方法研究包括一项准实验前-后研究和一项定性研究。整合模型包括培训 HCP 管理 AUD、引入 AUD 系统筛查、记录 AUD 服务利用情况和提供支持性监督。我们收集了在试行服务模式前三个月和后三个月内发现 AUD 人数的信息。使用非参数趋势检验，即无分布累积和检验，以确定在试行基于设施的综合 AUD 干预措施后，AUD 识别率的变化是否超出了由于季节性趋势或偶然因素导致的变化。使用曼-肯德尔检验评估趋势的统计学显著性。我们进行了三次焦点小组讨论，探讨 HCP 的经验以及他们对促进因素、障碍和克服障碍的策略的看法。使用主题分析对焦点小组讨论进行分析。
在调整后的 AUD 模型的基于设施的干预措施的实施前阶段，HCP 在三个月内对 322 人进行了 AUD 评估，每月最低评估 99 人，最高评估 122 人。其中，有 77 人被确定为 AUD。此外，HCP 在实施期间对 2058 人进行了 AUD 筛查；三个月内，每月筛查出 AUD 阳性的人数最少为 528 人，最多为 843 人（AUDIT≥8）。然而，这种 AUD 筛查的变化在统计学上并不显著（p 值=0.06）。HCP 报告称，培训中的知识和技能帮助他们识别和支持那些他们通常不会认为有问题的酒精使用者。实施方面的障碍包括卫生人员与需求相比不足和不方便的卫生管理信息系统。HCP 提出了克服这些因素的策略，并建议超越卫生系统开展多部门参与。
尽管 HCP 筛查 AUD 的人数趋势在实施后的变化在统计学上并不显著，但在解决已确定的瓶颈和实施策略的同时，仍有可能实施调整后的基于设施的 AUD 综合模型的组成部分。因此，需要进行一项大规模的、有足够能力的实施可行性研究。本研究的结果将用于最终确定针对 AUD 干预措施的调整模型，以便将来实施和更大规模的评估。
