A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2000-2021]
    • Subject Terms:
      Primary Health Care* ; Quality Improvement* ; Total Quality Management*; Alcoholism/*diagnosis ; Alcoholism/*therapy; Alcohol Drinking ; Alcohol-Related Disorders/diagnosis ; Alcohol-Related Disorders/therapy ; Humans ; Implementation Science ; Mass Screening
    • Abstract:
      Background: Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements.
      Methods: We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes.
      Results: Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements.
      Conclusion: Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).
    • References:
      J Public Health (Oxf). 2011 Sep;33(3):412-21. (PMID: 21169370)
      BMJ Qual Saf. 2014 Apr;23(4):290-8. (PMID: 24025320)
      BMC Public Health. 2013 Apr 22;13:375. (PMID: 23607755)
      Am J Prev Med. 2008 Nov;35(5 Suppl):S373-80. (PMID: 18929984)
      Med J Aust. 2007 Oct 15;187(8):453-7. (PMID: 17937642)
      J Stud Alcohol. 2004 Mar;65(2):191-9. (PMID: 15151349)
      Front Public Health. 2016 May 04;4:86. (PMID: 27200338)
      Arch Med Sci. 2012 Sep 8;8(4):704-10. (PMID: 23056084)
      Scand J Prim Health Care. 2006 Mar;24(1):5-15. (PMID: 16464809)
      BMJ Open. 2016 Jun 16;6(6):e010271. (PMID: 27311902)
      J Stud Alcohol. 2005 May;66(3):379-88. (PMID: 16047527)
      Prev Med. 1999 Dec;29(6 Pt 1):478-86. (PMID: 10600428)
      Addict Sci Clin Pract. 2019 Feb 12;14(1):6. (PMID: 30744686)
      Pediatrics. 2001 May;107(5):1100-7. (PMID: 11331693)
      Subst Abuse Treat Prev Policy. 2013 Feb 28;8:9. (PMID: 23448579)
      J Gen Intern Med. 2006 Dec;21(12):1269-75. (PMID: 16965560)
      Patient Educ Couns. 2003 Nov;51(3):277-84. (PMID: 14630384)
      BMC Fam Pract. 2006 Jul 12;7:44. (PMID: 16836761)
      Alcohol Alcohol. 2017 Mar 9;52(2):197-205. (PMID: 28182195)
      J Community Health. 1992 Dec;17(6):323-31. (PMID: 1293139)
      Addiction. 2008 Aug;103(8):1271-80. (PMID: 18422825)
      Alcohol Alcohol. 2004 Jul-Aug;39(4):351-6. (PMID: 15208170)
      Transl Behav Med. 2016 Jun;6(2):212-9. (PMID: 27356991)
      Aust J Rural Health. 2011 Jun;19(3):111-7. (PMID: 21605223)
      Subst Abus. 2005 Mar;26(1):23-31. (PMID: 16492660)
      Fam Pract. 1999 Dec;16(6):551-7. (PMID: 10625125)
      Addiction. 2012 Sep;107(9):1601-11. (PMID: 22372573)
      J Stud Alcohol Drugs. 2016 May;77(3):500-8. (PMID: 27172583)
      BMJ Qual Saf. 2011 Dec;20(12):1011-9. (PMID: 21727199)
      BMC Fam Pract. 2014 Dec 16;15:201. (PMID: 25512086)
      Front Public Health. 2017 Mar 24;5:45. (PMID: 28393064)
      BMC Health Serv Res. 2013 Feb 09;13:54. (PMID: 23394573)
      Implement Sci. 2017 Aug 22;12(1):105. (PMID: 28830568)
      Br J Gen Pract. 1999 Sep;49(446):699-703. (PMID: 10756610)
      Int J Environ Res Public Health. 2017 Sep 08;14(9):. (PMID: 28885557)
      Drug Alcohol Depend. 2003 Jan 24;69(1):9-14. (PMID: 12536061)
      Health Promot J Austr. 2016 Feb;27(3):204-207. (PMID: 29241482)
      BMC Health Serv Res. 2018 Jul 11;18(1):541. (PMID: 29996836)
      Fam Med. 1997 May;29(5):332-5. (PMID: 9165285)
      Am J Prev Med. 2014 Oct;47(4):424-34. (PMID: 25240966)
      Aust Fam Physician. 2017 Jan/Feb;46(1):65-69. (PMID: 28189136)
      J Gen Intern Med. 2007 Aug;22(8):1144-9. (PMID: 17541671)
      Addiction. 2016 Nov;111(11):1935-1945. (PMID: 27237081)
      Med Care. 2012 Feb;50(2):179-87. (PMID: 20881876)
      Fam Pract Res J. 1994 Mar;14(1):41-9. (PMID: 8048347)
      Drug Alcohol Rev. 2013 Jan;32(1):72-9. (PMID: 22775591)
      Med Care. 2012 Mar;50(3):217-26. (PMID: 22310560)
      J Health Organ Manag. 2018 Jun 18;32(4):545-571. (PMID: 29969347)
      Alcohol Alcohol. 2017 Sep 01;52(5):595-609. (PMID: 28591801)
      Soc Sci Med. 1998 Jul;47(2):203-11. (PMID: 9720639)
      J Gen Intern Med. 2002 May;17(5):315-26. (PMID: 12047727)
      Health Psychol. 2008 Sep;27(5):513-22. (PMID: 18823177)
      Drug Alcohol Depend. 2012 Aug 1;124(3):207-15. (PMID: 22361211)
      Ann Fam Med. 2017 Jul;15(4):335-340. (PMID: 28694269)
      J Stud Alcohol Drugs. 2013 Jul;74(4):598-604. (PMID: 23739024)
      Int J Qual Health Care. 2014 Feb;26(1):6-15. (PMID: 24311732)
      J Prim Care Community Health. 2014 Jan 1;5(1):50-4. (PMID: 24327588)
      BMJ Open. 2015 Dec 11;5(12):e009397. (PMID: 26656984)
      Pediatrics. 2005 Apr;115(4):960-8. (PMID: 15805371)
      BMC Fam Pract. 2005 Nov 04;6:46. (PMID: 16271146)
      Ann Intern Med. 2003 Mar 4;138(5):372-82. (PMID: 12614089)
      BMC Health Serv Res. 2014 Nov 19;14:578. (PMID: 25408165)
      Curr Opin Psychiatry. 2018 Jul;31(4):324-332. (PMID: 29846264)
      Appl Nurs Res. 2009 Nov;22(4):243-9. (PMID: 19875038)
      BMC Fam Pract. 2016 Nov 25;17(1):165. (PMID: 27887577)
      J Public Health (Oxf). 2014 Sep;36(3):450-9. (PMID: 24375203)
      BMJ. 1992 Jan 25;304(6821):227-30. (PMID: 1739798)
      Alcohol Alcohol. 2014 Sep-Oct;49(5):531-9. (PMID: 25031247)
      BMJ Open. 2017 Oct 5;7(10):e016626. (PMID: 28982818)
      Addiction. 2015 Sep;110(9):1404-15. (PMID: 25913697)
      Addiction. 2015 Dec;110(12):1877-900. (PMID: 26234486)
      Addict Sci Clin Pract. 2018 Apr 9;13(1):8. (PMID: 29628018)
      J Eval Clin Pract. 2014 Dec;20(6):1137-43. (PMID: 25266778)
      BMC Pregnancy Childbirth. 2016 May 24;16:118. (PMID: 27221473)
      J Subst Abuse Treat. 2017 Nov;82:107-112. (PMID: 29021108)
      Addict Sci Clin Pract. 2015 Nov 19;10:26. (PMID: 26585638)
      Acad Med. 2015 Dec;90(12):1707-12. (PMID: 26200578)
    • Contributed Indexing:
      Keywords: Alcohol; Alcohol use disorders; Brief intervention; Continuous quality improvement; Implementation; Primary health care; Screening; Treatment; Unhealthy alcohol use
    • Publication Date:
      Date Created: 20200215 Date Completed: 20201130 Latest Revision: 20240328
    • Publication Date:
      20240329
    • Accession Number:
      PMC7020510
    • Accession Number:
      10.1186/s12875-020-1101-x
    • Accession Number:
      32054450