Alcohol is a major source of harm. More than 1200 deaths each year and 43,736 Disability Adjusted Life Years (DALYs) attributable to alcohol in Victoria alone. Risky alcohol use has ramifications for health and wellbeing, and effects families and the wider community through absenteeism, family violence, assaults, and motor vehicle collisions. People from low income groups are affected by alcohol related harms more, and at lower levels of alcohol intake than people from higher income groups.
General practice plays an essential role in reducing alcohol-related harm in communities, as nearly 85% of Victorians see a GP at least annually. Brief interventions (BI’s) involve assessing the amount of alcohol a person is using, and offering individualised advice on how to reduce the associated health risks. These are effective in reducing the average amount of alcohol people consume in a week, and are recommended in the RACGP Preventive Care guidelines for all patients over the age of 15 years. Despite their effectiveness, and the support for this approach in evidence-based guidelines, clinicians do not routinely provide this intervention in daily practice.
To better support clinicians to provide brief interventions for alcohol in general practice. Through a collaboration with patients and clinicians, we will develop a new approach to increase the use of brief interventions in General Practice across Victoria. The focus will ensure the approach is most acceptable, feasible and effective for low-income patients.
We will co-design a new approach with patients and practitioners that increases the uptake of brief interventions (BI’s) for alcohol use in general practice. Brief interventions include motivational interviewing, patient education and awareness raising, and goal setting. Our team will develop methods to increase patient screening for alcohol use in a way that is acceptable and appropriate for patients. We will also increase practitioner engagement with existing BI strategies, and provide appropriate clinical resources to support this.
GPs, practice nurses and practice management/administration will be engaged via outreach practice visits, virtual focus groups and face-to-face focus groups. People from low income groups and their advocates will be engaged via social listening, where discussions are had on social media platforms such as Facebook and individual interviews.
We will test a new approach for embedding brief interventions for alcohol in general practice.
We will partner with five General Practices situated in low-income communities in North West and South East Melbourne to test the new package of resources. We will use both qualitative and quantitative data to assess the acceptability, feasibility, and relative effectiveness of the intervention
Our data collection methods include:
A waiting room survey for patients after their appointment that asks if they discussed alcohol with their doctor or nurse and how they found the experience. All patients will be invited to participate. The survey will be available in English and the two most common community languages.
An SMS survey for patients identified as drinking alcohol above recommendations that asks about alcohol consumption and behaviour change. The survey will be administered at 3, 6, 9 and 12 months after their appointment
A practice survey to document how conversations about alcohol occur in the practice and how information is captured in the patient record
The “NoMAD” tool for clinicians and practice administrative staff to provide feedback on how the intervention was implemented in their practice
A practice data extract to measure changes to how alcohol histories are documented in the patient medical record.
A short interview with a subset of patients to provide further feedback about the acceptability of the intervention
An interview with a subset of clinicians are each practice to provide further feedback on acceptability and feasibility of the intervention.
Patients from low-incomes groups will be recruited from the General Practice waiting room by a research assistant. They will be asked to complete a short survey after their appointment about whether they were asked about alcohol use, and how they found the experience. All patients will be surveyed to remove fear of judgement, and subsequent desirability bias. The survey will be provided in English plus the two most common other languages in the community.
Patients will be invited to participate in a short interview with the researcher to provide further feedback about the acceptability of the intervention. Approximately 20 patients will be interviewed across the five practices. We will complete a thematic analysis of the interviews focusing on the acceptability of the intervention for patients.
The “NoMAD” tool will be completed by clinicians and practice administrative staff to assess how the intervention works in General Practice. Clinicians from each practice will be interviewed, with subsequent thematic analysis focusing on feasibility of the intervention in a practice setting.
The primary outcome will be the change in practitioner uptake of BI’s for alcohol at six months.
We are also interested in measuring the change in patient alcohol consumption after implementation of the intervention. We will recruit 140 patients who have higher levels of alcohol intake from across the five practices (as identified by their practitioner) and ask them to complete an online survey about their alcohol intake every three months, for a 12 month period.
A subgroup analysis based on socioeconomic status will be competed to ensure that our intervention is effective for low-income patients.