Training general practitioners in remote Western Australia in a method of screening and brief intervention for harmful alcohol use: a pilot study.

OBJECTIVE: High levels of alcohol-related harm are a salient feature of many rural communities in Australia. General practitioners (GPs) are uniquely placed to identify and treat patients with harmful alcohol use in remote settings, yet corresponding opportunities for education in effective brief psychological interventions for harmful alcohol use are limited. This study piloted a training model for alcohol screening and brief intervention for GPs working in Kalgoorlie-Boulder, a remote Western Australian community facing significant alcohol-related problems. DESIGN: Observational pilot study. SETTING: Primary care. MAIN OUTCOME MEASURE(S): Perceived role in responding to harmful alcohol use, and confidence and knowledge of alcohol screening and brief intervention; satisfaction with a short training session focused on alcohol screening and brief intervention; and impact of training on implementation of screening and brief intervention for harmful alcohol use. RESULTS: Fifty per cent of GPs took up the training opportunity. GPs recognised their professional responsibility for conducting brief intervention but reported comparatively lower confidence and skills in implementing screening and intervention prior to training. The training improved knowledge and confidence in conducting alcohol screening and brief intervention. All GPs increased their frequency of alcohol screening, and 88% of GPs reported increasing the frequency of brief intervention at 6 months. CONCLUSIONS: Preliminary findings suggest that among participating GPs, subsequent compliance with identification and management of harmful alcohol use was improved. Further work examining methods to improve rural and remote GP participation in alcohol-related harm prevention training is required, as the potential impact on communities with disproportionately high alcohol-related difficulties is significant.

Screening for harmful alcohol use in Australian trauma settings.

INTRODUCTION: High rates of trauma recidivism associated with alcohol use indicate the need to screen for alcohol consumption and related harm. Routine collection of prevalence data relating to alcohol use in Australian trauma settings is not undertaken currently, and diverse screening approaches are used across different settings. This study sought to examine the feasibility of routine screening for alcohol related injury and harmful alcohol use, and determine the prevalence of alcohol related injury and risky alcohol consumption amongst trauma patients in Western Australia. METHODS: A step-down model of screening for alcohol-related injury and harmful alcohol consumption was developed and trialled. Over a four month period at a statewide trauma service, 729 non-head injured trauma patients were screened using a two-item measure in emergency and acute surgical settings, and 538 patients who screened positive were subsequently administered a standardised self report measure of alcohol consumption. RESULTS: There was a 49% compliance rate with the Emergency Department brief screening protocol for alcohol related injury. Of those screened, 77% were identified by clinical staff as potentially having had an alcohol related injury or be engaging in risky drinking regularly. Sixty per cent of the screened patients who subsequently completed a standardised self report measure were identified as drinking at harmful levels (41% hazardous; 7% harmful; 12% dependent). Of these, 15% and 24% met the DSM-IV-TR criteria for alcohol abuse and dependence respectively. Approximately 30% of patients diagnosed with an alcohol use disorder were not identified by staff as having an alcohol-related injury or problem. Higher alcohol consumption was significantly associated with greater risk of depression and PTSD. CONCLUSIONS: Preliminary findings suggest a high prevalence of alcohol-related injury, and harmful alcohol consumption. These findings point to an urgent need to develop reliable and economical screening protocols for harmful alcohol use across Australian trauma settings and the adoption of strategies to ensure their compliance, to enable accurate identification of those most likely to benefit from interventions to reduce alcohol related harm.