支持澳大利亚原住民初级保健中的酒精简短干预和药物治疗提供：一项集群随机试验的探索性分析。
Supporting alcohol brief interventions and pharmacotherapy provision in Australian First Nations primary care: exploratory analysis of a cluster randomised trial.
机构信息
Faculty of Medicine and Health, Discipline of Addiction Medicine, The University of Sydney, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Lev 6, King George V Building (C39), Sydney, NSW, 2006, Australia.
The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Royal Prince Alfred Hospital (KGV), 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.
出版信息
BMC Prim Care. 2024 Sep 28;25(1):351. doi: 10.1186/s12875-024-02598-9.
INTRODUCTION
Primary care provides an important opportunity to detect unhealthy alcohol use and offer assistance but many barriers to this exist. In an Australian context, Aboriginal Community Controlled Health Services (ACCHS) are community-led and run health services, which provide holistic primary care to Aboriginal and Torres Strait Islander peoples. A recent cluster randomised trial conducted with ACCHS provided a service support model which showed a small but significant difference in provision of 'any treatment' for unhealthy alcohol use. However, it was not clear which treatment modalities were increased.
AIMS
To test the effect of an ACCHS support model for alcohol on: (i) delivery of verbal alcohol intervention (alcohol advice or counselling); (ii) prescription of relapse prevention pharmacotherapies.
METHODS
Intervention: 24-month, multi-faceted service support model.
DESIGN
cluster randomised trial; equal allocation to early-support ('treatment') and waitlist control arms.
PARTICIPANTS
22 ACCHS.
ANALYSIS
Multilevel logistic regression to compare odds of a client receiving treatment in any two-month period as routinely recorded on practice software.
RESULTS
Support was associated with a significant increase in the odds of verbal alcohol intervention being recorded (OR = 7.60, [95% CI = 5.54, 10.42], p < 0.001) from a low baseline. The odds of pharmacotherapies being prescribed (OR = 1.61, [95% CI = 0.92, 2.80], p = 0.1) did not increase significantly. There was high heterogeneity in service outcomes.
CONCLUSIONS
While a statistically significant increase in verbal alcohol intervention rates was achieved, this was not clinically significant because of the low baseline. Our data likely underestimates rates of treatment provision due to barriers documenting verbal interventions in practice software, and because different software may be used by drug and alcohol teams. The support made little impact on pharmacotherapy prescription. Changes at multiple organisational levels, including within clinical guidelines for primary care, may be needed to meaningfully improve provision of alcohol treatment in ACCHS.
TRIAL REGISTRATION
ACTRN12618001892202 (retrospectively registered on 21/11/2018).
简介
初级保健为发现不健康的饮酒行为并提供帮助提供了重要机会，但存在许多障碍。在澳大利亚背景下，原住民社区控制的医疗服务（ACCHS）是由社区领导和运营的医疗服务机构，为原住民和托雷斯海峡岛民提供整体初级保健。最近在 ACCHS 进行的一项集群随机试验提供了一种服务支持模式，该模式显示在提供“任何治疗”以治疗不健康的饮酒方面存在微小但显著的差异。然而，尚不清楚增加了哪些治疗方式。
目的
测试 ACCHS 支持模型对以下方面的影响：（i）提供口头酒精干预（酒精建议或咨询）；（ii）处方预防复发的药物治疗。
方法
干预：24 个月，多方面的服务支持模式。
设计
集群随机试验；均衡分配到早期支持（“治疗”）和候补控制组。
参与者
22 个 ACCHS。
分析
多水平逻辑回归比较每个两个月期间客户接受治疗的可能性，这是在实践软件中常规记录的。
结果
支持与口头酒精干预记录的可能性显著增加相关（OR=7.60，[95%CI=5.54, 10.42]，p<0.001），从低基线开始。开处方药物治疗的可能性（OR=1.61，[95%CI=0.92, 2.80]，p=0.1）没有显著增加。服务结果存在高度异质性。
结论
虽然口头酒精干预率的统计显着增加，但由于基线较低，这并没有临床意义。由于在实践软件中记录口头干预存在障碍，并且由于药物和酒精团队可能使用不同的软件，我们的数据可能低估了治疗提供的比率。支持对药物治疗处方几乎没有影响。可能需要在多个组织层面进行更改，包括初级保健临床指南中的更改，才能在 ACCHS 中切实改善酒精治疗的提供。
试验注册
ACTRN12618001892202（于 2018 年 11 月 21 日回顾性注册）。
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