Abstract
BackgroundPharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited. Primary care could be a key setting for identification and continuous care for AUD due to accessibility, low cost and acceptability to patients.We aimed to synthesise the literature regarding differential models of care for the management of AUD in primary health care settings.MethodsWe conducted a systematic review of articles published worldwide (1998-present) using the following databases; Medline, PsycINFO, Cochrane database of systematic reviews, Cochrane Central Register of Controlled Trials and Embase. The Grey Matters Tool guided the grey literature search. We selected randomised controlled trials evaluating the effectiveness of a primary care model in the management of AUD. Two researchers independently assessed and then reached agreement on the included studies. We used the Cochrane risk of bias tool 2.0 for the critical appraisal.ResultsEleven studies (4186 participants) were included. We categorised the studies into ‘lower’ versus ‘higher’ intensity given the varying intensity of clinical care evaluated across the studies. Significant differences in treatment uptake were reported by most studies. The uptake of AUD medication was reported in 5 out of 6 studies that offered AUD medication. Three studies reported a significantly higher uptake of AUD medication in the intervention group. A significant reduction in alcohol use was reported in two out of the five studies with lower intensity of care, and three out of six studies with higher intensity of care.ConclusionOur results suggest that models of care in primary care settings can increase treatment uptake (e.g. psychosocial and/or pharmacotherapy) although results for alcohol-related outcomes were mixed. More research is required to determine which specific patient groups are suitable for AUD treatment in primary health care settings and to identify which models and components are most effective.Trial RegistrationPROSPERO: CRD42019120293.
Highlights
Pharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited
Eligibility criteria Studies were eligible if: 1) they were published in English, 2) they were published after 1 January 1998, 3) they compared models for the management of AUD, and 4) at least 80% or more of the subjects had an AUD, or if results for subjects with AUD were presented separately to those with other conditions
Identification of hazardous alcohol use or AUD differed among the studies, ranging from utilizing assessment tools to more formal diagnosis of AUD using the International Statistical Classification of Diseases (10th revision) (ICD-10) or according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for current alcohol dependence
Summary
Pharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited. Primary care could be a key setting for identification and continuous care for AUD due to accessibility, low cost and acceptability to patients. We aimed to synthesise the literature regarding differential models of care for the management of AUD in primary health care settings. Alcohol use disorder (AUD) is highly prevalent and contributes to 4% of the global disease burden and 5.3% of mortality worldwide [1]. A significant proportion of AUD patients access primary health care, albeit for other reasons [9], and this represents an opportunity for earlier intervention. Primary health care appears to be an ideal treatment setting for AUD due to this accessibility and due to low costs and acceptability for patients
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