Abstract
Background:While primary health care (PHC)-based prevention and management of alcohol use disorder (AUD) is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of AUD, operationalized by heavy drinking, in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion:This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment.
Highlights
Alcohol use disorder Alcohol use disorder (AUD) is a summary term used for the two diagnosable conditions of “harmful use of alcohol” and “alcohol dependence” within the World Health Organisation (WHO) ICD-10 classification of mental and behavioural disorders[1]
This can be understood as a failure to equitably scale up excellent care to ensure that what we know works is delivered to everyone who needs it
There is a wealth of literature on implementation science and quality improvement, and a range of frameworks exist that include a sequential approach for scale-up, and that provide practical guidance for how to work with organizations, health systems, and communities to implement and scale-up best practices[76,77,78,79,80,81,82,83]
Summary
Alcohol use disorder Alcohol use disorder (AUD) is a summary term used for the two diagnosable conditions of “harmful use of alcohol” and “alcohol dependence” within the World Health Organisation (WHO) ICD-10 classification of mental and behavioural disorders[1]. While primary health care (PHC)-based prevention and management of alcohol use disorder (AUD) is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. Protocol: A quasi-experimental study will compare PHC-based prevention and management of AUD, operationalized by heavy drinking, in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. Discussion: This multi-country study will test the extent version 1 to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of published 23 Mar 2017 more patients with heavy drinking receiving appropriate advice and treatment
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