REACH Project: Reducing Alcohol-related harm in General Practice

Context: Alcohol brief interventions involve assessing a person’s alcohol use and offering individualised advice to reduce health risks. These are effective in reducing the average amount of alcohol people consume in a week. Despite their effectiveness, clinicians may find it difficult to offer brief interventions in daily practice. Aim: To better support clinicians to provide brief interventions for alcohol in general practice 1. Physical or informational materials: an innovative resource pack with materials including patient priming materials, clinician resources and consultation resources. Resources were designed specifically for this study. Content was adapted from evidence based resources (1-4)* - Waiting room poster that shows the health harms of alcohol and shows the names of GPs at the practice who are particularly interested or skilled in helping their patients manage their alcohol use. - Waiting room survey that includes questions about smoking, nutrition, alcohol and physical activity that patients can fill in while they wait for their doctor or nurse. Patients and clinicians can use the completed form as a way of starting a discussion about alcohol. - “Talk to me about alcohol” signs to be displayed in doctors’ and nurses’ offices encouraging patients to bring up their alcohol use during their consultation. - Brief interventions flowchart and standard drinks guide shows the steps to delivering an alcohol brief intervention, including, asking about alcohol intake, advising patients about the risks from their alcohol use, assessing readiness to change and motivational interviewing tips, and referral options. The standard drinks guide can be used to quantify alcohol intake. - Alcohol intake and health risks charts show how the risk for cancer (breast, prostate, colorectal) and stroke increase with increasing alcohol intake. Clinicians were encouraged to keep these charts alongside other clinical resources in the consultation room and discuss them with patients when delivering the brief intervention to their patients. - Podcast featuring clinicians speaking about brief interventions for alcohol in general practice and how they encourage behaviour change to reduce alcohol related harms among patients. Clinicians were encouraged to listen to the 1 hour podcast and adapt their practice based on the insights offered. - Patient brochures present the national recommendations on alcohol intake (NHMRC), the health harms of alcohol use, the benefits of reducing alcohol intake including practical strategies for managing cravings and triggers, a standard drinks guide, and where to go for more help. Patient brochures are available in multiple languages. 2. Intervention procedures - Practices will identify a champion to promote the intervention to their colleagues. After the resources are introduced by practice engagement staff, practice champions will use existing practice communication channels e.g. weekly practice meetings or emails to raise awareness of practice staff about the resources, promote the use of resources during the trial period, liaise with primary care commissioning organisation (Primary Health Network) staff to troubleshoot any issues with resource use and share practice performance information with staff. - Practice engagement staff from a primary care commissioning organisation (Primary Health Network) will support implementation at the practice with quarterly, 30 minute to 1 hour visits or telephone calls to provide ongoing feedback on practice performance and to promote use of the clinical resources. The practice champion will receive a written performance report and will be asked about whether and how resources are used with the intention of encouraging routine use. Practice champions will be offered additional information on the evidence behind the resources or additional clinical or referral information relating to alcohol harm reduction as needed. The practice champion will be encouraged to distribute the information they receive to other staff at the practice. Who - Practice visits will be delivered by practice engagement staff with knowledge of general practice operations and expertise in primary care relationship management/data use and interpretation. - General practitioners or practice nurses will deliver alcohol brief interventions to patients. Mode of delivery - Practice visits will be delivered in group settings via telephone or videoconferencing due to pandemic restrictions during the intervention period. - Alcohol brief interventions will be delivered face-to-face or via telehealth to individual patients. Frequency - Practice visits will occur quarterly over the 1 year intervention period, with a total of four contacts. - Alcohol brief interventions can be delivered in a single consultation (10 minutes per session) or over 2 or more consultations as deemed appropriate by the clinician and patient. All patients who attend the practice during the trial period and meet the eligibility criteria will be offered the intervention. Location - All activities will be conducted with general practice settings. Personalisation - Participating practices will receive additional support and information from the primary care commissioning organisation staff as needed. - Patients will receive support for risky alcohol use as clinically indicated. The RE-AIM framework will be used to assess implementation. Measures include Reach: the change in proportion of patient records with information on alcohol status (drinks alcohol; does not drink alcohol) as a proxy marker for where a brief intervention (BI) is likely to have occurred. Acceptability: to patients, clinicians, practice staff, and PHN staff. Adoption: within each practice and within the PHN processes. Fidelity of intervention implementation via project timelines completed by the PHN, research team, and member-checked during provider interviews. Sustainability as perceived by practice staff, clinicians, and PHN staff. Data on acceptability, adoption, fidelity and sustainability will be collected by the research team using semi-structured interviews. References 1. How much is too much? In: National Health Service U, editor. Online2007. 2. Saunders JB, Aasland OG, Amundsen A, Grant M. Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption--I. Addiction. 1993;88(3):349-62. 3. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993;88(6):791- 804. 4. Canadian Centre on Substance Use and Addiction. Knowing your limits with alcohol 2019 [Available from: https://www.ccsa.ca/sites/default/files/2019-08/CCSA-Knowing- Your-Limits-with-Alcohol-Guide-2019-en_0.pdf.