Building workforce capacity to address substance use in primary health care: preliminary results from a mixed-methods pilot program

Matthew W. R. Stevens; Rowena Ivers; Joanne Telenta; Robert L. Ali

doi:10.1071/PY23148

RESEARCH ARTICLE (Open Access)

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Building workforce capacity to address substance use in primary health care: preliminary results from a mixed-methods pilot program

Matthew W. R. Stevens

^A ^* , Rowena Ivers

^B , Joanne Telenta

^C and Robert L. Ali

^A

+ Author Affiliations

- Author Affiliations

^A Department of Pharmacology, School of Biomedicine, The University of Adelaide, Adelaide, SA 5000, Australia.

^B Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.

^C COORDINARE – Southeastern NSW PHN, Wollongong, NSW 2500, Australia.

^* Correspondence to: matthew.stevens@adelaide.edu.au

Australian Journal of Primary Health 30, PY23148 https://doi.org/10.1071/PY23148

Submitted: 8 August 2023 Accepted: 4 December 2023 Published: 21 December 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Primary health care is critical to the prevention of alcohol, tobacco and other drug-related harms. Scaling-up screening, brief intervention and referral to treatment (SBIRT) within primary health care can reduce the burden of substance-related diseases, and improve downstream healthcare services. Building knowledge, skills and confidence among general practitioners (GPs), particularly in rural, regional and remote areas, to deliver SBIRT is an essential step. Therefore, this study aimed to pilot test a skills-based training program for GPs designed to build capacity for SBIRT delivery.

Methods

This pilot study investigated the acceptability of a structured, educational skills-based training program among GPs, as well as its preliminary effectiveness in inducing changes in confidence to deliver SBIRT, and in increasing knowledge about low-risk alcohol guidance. The training package was designed by experts in addiction medicine and public health, and involved a series of online webinars and in-person workshops at four locations across the South Eastern NSW Primary Healthcare Network catchment.

Results

A total of 18 GPs registered for the training, with six completing the final webinar. The GPs who completed all sessions demonstrated increases in confidence to deliver SBIRT and alcohol guidance knowledge from baseline. Qualitative feedback found the program acceptable, and GPs were able to successfully implement learnings into practice, and promote to colleagues.

Conclusions

The results indicated the potential of this program at a national level, but highlighted the need for a range of additional incentives to encourage uptake and ongoing implementation.

Keywords: alcohol, ASSIST, dependence, general practice, primary healthcare, rural medicine, SBIRT, secondary prevention, substance use.

References

Agerwala SM, McCance-Katz EF (2012) Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. Journal of Psychoactive Drugs 44(4), 307-317.
| Crossref | Google Scholar | PubMed |

AIHW (2020) National drug strategy household survey 2019. Drug Statistics series no. 32. PHE 270. AIHW, Canberra.

AIHW (2022) Medicare-subsidised GP, allied health and specialist health care across local areas: 2023-22. AIHW, Canberra.

Anderson P, Kaner E, Wutzke S, Wensing M, Grol R, Heather N, Saunders J (2003) Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey. Alcohol and Alcoholism 38(6), 597-601.
| Crossref | Google Scholar | PubMed |

Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J (2007) Screening, Brief Intervention, and Referral to Treatment (SBIRT) toward a public health approach to the management of substance abuse. Substance Abuse 28(3), 7-30.
| Crossref | Google Scholar | PubMed |

DiClemente CC, Corno CM, Graydon MM, Wiprovnick AE, Knoblach DJ (2017) Motivational interviewing, enhancement, and brief interventions over the last decade: a review of reviews of efficacy and effectiveness. Psychology of Addictive Behaviors 31(8), 862-887.
| Crossref | Google Scholar | PubMed |

Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW (2008) A meta-analytic review of psychosocial interventions for substance use disorders. American Journal of Psychiatry 165(2), 179-187.
| Crossref | Google Scholar | PubMed |

Fischer F, Lange K, Klose K, Greiner W, Kraemer A (2016) Barriers and strategies in guideline implementation – a scoping review. Healthcare 4(3), 36.
| Crossref | Google Scholar |

Garner BR, Godley SH, Dennis ML, Hunter BD, Bair CML, Godley MD (2012) Using pay for performance to improve treatment implementation for adolescent substance use disorders: results from a cluster randomized trial. Archives of Pediatrics & Adolescent Medicine 166(10), 938-944.
| Crossref | Google Scholar | PubMed |

Goldbeck R, Asif M, Sanderson M, Farquharson C (2012) Alcohol and drug misuse, risk of re-admission to a general hospital and psychiatric contact. Scottish Medical Journal 57(1), 1-5.
| Crossref | Google Scholar |

Grol R (1997) Personal paper: beliefs and evidence in changing clinical practice. BMJ 315(7105), 418-421.
| Crossref | Google Scholar | PubMed |

Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. The Lancet 362(9391), 1225-1230.
| Crossref | Google Scholar |

Humeniuk R, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwutikarn J, et al. (2008) Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction 103(6), 1039-1047.
| Crossref | Google Scholar | PubMed |

Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, et al. (2018) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews 2(2), CD004148.
| Crossref | Google Scholar |

Ketterer F, Symons L, Lambrechts M-C, Mairiaux P, Godderis L, Peremans L, et al. (2014) What factors determine Belgian general practitioners’ approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model. BMC Family Practice 15, 119.
| Crossref | Google Scholar |

Kowalski M, Barrett L (2020) Engaging general practice and General Practitioners in alcohol and other drug treatment. UNSW Social Policy Research Centre.

Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW (2009) Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug and Alcohol Dependence 99(1–3), 280-295.
| Crossref | Google Scholar | PubMed |

Miller NS, Sheppard LM, Colenda CC, Magen J (2001) Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Academic Medicine 76(5), 410-418.
| Crossref | Google Scholar | PubMed |

Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. (2020) Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. The Lancet 396(10258), 1223-1249.
| Crossref | Google Scholar |

National Health and Medical Research Council (NHMRC) (2020) Australian guidelines to reduce health risks from drinking alcohol. Commonwealth of Australia, Canberra.

O’Connor PG, Nyquist JG, McLellan AT (2011) Integrating addiction medicine into graduate medical education in primary care: the time has come. Annals of Internal Medicine 154(1), 56-59.
| Crossref | Google Scholar | PubMed |

Prentice S, Elliott T, Dorstyn D, Benson J (2023) Burnout, wellbeing and how they relate: a qualitative study in general practice trainees. Medical Education 57, 243-255.
| Crossref | Google Scholar | PubMed |

RACGP (2018) Guidelines for preventive activities in general practice (9th edn). RACGP, East Melbourne, Vic.

RACGP (2023) Alcohol and other drugs program: final report – Part B. RACGP, East Melbourne, Vic.

Rahm AK, Boggs JM, Martin C, Price DW, Beck A, Backer TE, Dearing JW (2015) Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings. Substance Abuse 36(3), 281-288.
| Crossref | Google Scholar | PubMed |

Roche AM, Hotham ED, Richmond RL (2002) The general practitioner’s role in AOD issues: overcoming individual, professional and systemic barriers. Drug and Alcohol Review 21(3), 223-230.
| Crossref | Google Scholar | PubMed |

Sara G, Lappin J, Dobbins T, Dunlop AJ, Degenhardt L (2017) Escalating patterns of emergency health care prior to first admission with amphetamine psychosis: a window of opportunity? Drug and Alcohol Dependence 180, 171-177.
| Crossref | Google Scholar | PubMed |

Stevens MWR, Harland J, Alfred S, Ali RL (2022) Substance use in the emergency department: screening for risky drug use, using the ASSIST-Lite. Drug and Alcohol Review 41(7), 1565-1576.
| Crossref | Google Scholar | PubMed |

Sturgiss EA, Advocat J, Nielsen S, Ball L, Barton C, Lam T, Gunatillaka N, Mazza D, O’Donnell R, Jacka D, Russell G, Stoukeris H, Tam M (2021) The REACH Project: Reducing alcohol related harm by embedding brief interventions in Victorian general practices. Victorian Health Promotion Foundation, Melbourne.

Wilson H, Schulz M, Rodgers C, Lintzeris N, Hall JJ, Harris-Roxas B (2022) What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners. Drug and Alcohol Review 41(5), 1152-1160.
| Crossref | Google Scholar | PubMed |