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https://hdl.handle.net/2440/136665
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Type: | Journal article |
Title: | Effects of service-wide support on regularity of alcohol screening of clients in Australian Aboriginal and Torres Strait Islander Community Controlled Health Services: a cluster randomised trial |
Author: | Dzidowska, M. Raubenheimer, J.E. Dobbins, T.A. Lee, K.S.K. Hayman, N. Vnuk, J. Haber, P. Conigrave, K.M. |
Citation: | Addiction Science and Clinical Practice, 2022; 17(1):1-12 |
Publisher: | BioMed Central |
Issue Date: | 2022 |
ISSN: | 1940-0632 1940-0640 |
Statement of Responsibility: | Monika Dzidowska, Jacques E. Raubenheimer, Timothy A. Dobbins, K. S. Kylie Lee, Noel Hayman, Julia Vnuk, Paul Haber, and Katherine M. Conigrave |
Abstract: | Background: We have previously shown that service-wide support can increase the odds of alcohol screening in any 2-month period in a cluster randomized trial of service-wide support to Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHS). Here we report an exploratory analysis on whether the resulting pattern of screening was appropriate. Aim: we assess whether that increase in screening was associated with: (i) increased frst-time screening, (ii) increased annual screening, (iii) whether frequently screened clients fell into one of four risk categories as defned by national guidelines. Methods: Setting and participants: 22 ACCHS; randomized to receive the support model in the treatment (‘earlysupport’) arm over 24-months or to the waitlist control arm. Intervention: eight-component support, including training, sharing of experience, audit-and-feedback and resource support. Analysis: records of clients with visits before and after start of implementation were included. Multilevel logistic modelling was used to compare (i) the odds of previously unscreened clients receiving an AUDIT-C screen, (ii) odds of clients being screened with AUDIT-C at least once annually. We describe the characteristics of a sub-cohort of clients who received four or more screens annually, including if they were in a high-risk category. Results: Of the original trial sample, 43,054 met inclusion criteria, accounting for 81.7% of the screening events in the overall trial. The support did not signifcantly increase the odds of frst-time screening (OR =1.33, 95% CI 0.81–2.18, p =0.25) or of annual screening (OR =0.99, 95% CI 0.42–2.37, p=0.98). Screening more than once annually occurred in 6240 clients. Of the 841 clients with four or more screens annually, over 50% did not fall into a high-risk category. Females were overrepresented. More males than females fell into high-risk categories. Conclusion: The signifcant increase in odds of screening observed in the main trial did not translate to signifcant improvement in frst-time or annual screening following implementation of support. This appeared to be due to some clients being screened more frequently than annually, while more than half remained unscreened. Further strategies to improve alcohol screening should focus on appropriate screening regularity as well as overall rates, to ensure clinically useful information about alcohol consumption. Trial Registration ACTRN12618001892202, retrospectively registered 16 November 2018 https://anzctr.org.au/Trial/ Registration/TrialReview.aspx?ACTRN=12618001892202. |
Keywords: | Alcohol Training and support Alcohol screening Screening patterns Indigenous Aboriginal Torres Strait Islander Continuous quality improvement AUDIT-C Primary care |
Rights: | © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
DOI: | 10.1186/s13722-022-00294-6 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1155320 http://purl.org/au-research/grants/nhmrc/1105339 http://purl.org/au-research/grants/nhmrc/1117198 http://purl.org/au-research/grants/nhmrc/1117582 |
Published version: | http://dx.doi.org/10.1186/s13722-022-00294-6 |
Appears in Collections: | Public Health publications |
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hdl_136665.pdf | Published version | 1.01 MB | Adobe PDF | View/Open |
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