Increasing uptake of evidence-based management of unhealthy alcohol use in Aboriginal primary health care services

June 2016

NDRI: Professor Dennis Gray, Associate Professor Ted Wilkes

NDARC: Associate Professor Timothy Dobbins

Other investigators: 

Professor Katherine Conigrave, Royal Prince Alfred Hospital, Sydney (Lead Investigator)
Professor Paul Haber, Royal Prince Alfred Hospital, Sydney
David Scrimgeour, University of Adelaide
Associate Professor Noel Hayman, Inala Indigenous Health Service
Doctor Kylie Lee, University of Sydney
Associate Professor Rowena Ivers, University of Wollongong
Mr Scott Wilson, Aboriginal Drug and Alcohol Council South Australia

Project description: 

Because of ongoing trauma, stress and disadvantage, Aboriginal and Torres Strait Islander (Indigenous) Australians face a greater risk of developing unhealthy drinking patterns and related harms than other Australians. Indigenous Australians have 2-8 times the risk of hospitalisation due to alcohol related causes, and alcohol leads to a wide range of physical, mental and social harms. Alcohol’s adverse effects impact on the drinker, their family and the whole community, including future health of babies and children. Despite this toll, community and health professional consultation indicates challenges in accessing treatment for alcohol problems.

Primary healthcare services targeting Indigenous Australians, including Aboriginal community controlled health services, have a unique role in providing accessible and appropriate health care. Yet there is wide variation in the extent to which such services provide the full range of treatments for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorders). In particular, there appears to be wide variety in the extent to which services offer early/brief interventions for low severity problems or indicated pharmacotherapy to reduce relapse risk where alcohol dependence has been diagnosed. Many barriers to routine implementation have been reported.

This cluster randomised controlled trial examines a sustainable approach to enhance uptake of evidence-based care for unhealthy alcohol use in primary health care services targeting Indigenous Australians. It utilises a collaborative approach to select and implement service-wide changes to optimise care. The effectiveness of the service-wide intervention will then be assessed by routinely downloaded data on implementation of screening and treatment, including pharmacotherapies. Any changes in consumption will be described.

The study is expected to result in sustainable service improvements, indicators for use in continuing quality improvement, and benefit to individuals, families and communities.