World Health Organization Collaborative Project on Identification and Management of Alcohol-related Problems

 in Primary Health Care

Phase IV

Development of Country-wide Strategies for Implementing Early Identification and Brief Alcohol Intervention in Primary Health Care.

Australia

[Customisation] [Communications] [Strategic Alliance] [Demonstration Project]

Final Country Chapter, January 2006

Collaborative Centre:

Centre for Drug & Alcohol Studies, Department of Psychiatry, University of Queensland & The Prince Charles Hospital & District Alcohol & Drug Service & The Royal Brisbane Hospital Alcohol & Drug Service

Chief Investigators:

John B Saunders - Professor Alcohol & Drug studies, University of Qld. Director, Alcohol & Drug Service, Prince Charles Hospital District Health Service.  Director, Royal Brisbane Hospital Alcohol & Drug Service

Nicole K Lee -  Research & Development Officer, Prince Charles Hospital District Health Service.Lecturer in Addiction Studies, University of Queensland

Co-Investigators/Steering Committee

Geographical Area in which Implementation Strategy will be Applied:

Queensland, Australia

Starting Date (i.e., overall Phase IV project):

Involvement from 1997, actual project to begin late 1999

Completion Date:

December 2003

Project Strands and Milestones:

Strand I: Development of study design, customisation of materials and techniques

Strand II: Demonstration project (first waves to begin late 1999/early 2000)

Strand III: Further customisation, refinement of and further demonstration project waves

Proposed Funding Sources:

Queensland Health (infrastructure & personnel)

Department of Psychiatry, University of Qld (personnel)

Applications currently to various funding bodies (NHMRC, Prince Charles Hospital Foundation, General Practice Evaluation Grants, Australian Brewers Foundation) for project funds

Local Support:

• Our steering committee is made up of a number of high profile researchers in the general practice, primary care and alcohol fields

• We have links with the Divisions of General Practice and are currently negotiating their involvement

• We are currently furthering our links with the Alcohol and Other Drug Coordinators throughout Queensland

CUSTOMIZING MATERIALS AND SERVICES

Early Identification (Screening):

We plan to utilise the Australian modified AusAUDIT and further customise the design of this through profession-specific focus groups.

Brief Intervention Package:

We plan to further develop the Drink Less package used in Phase III and further customise this through profession-specific and patient focus groups

Training of Primary Health Care Staff:

We have the access to the services of a senior alcohol and drug clinical trainer who will coordinate the development and customisation of the training package. In addition, he will be involved in the customisation of other materials and services.

Data Analysis:

A large part of the analyses will be performed by the Investigators and support staff. A specialist will be employed, if necessary, to perform further or complex analyses. We have identified a company for this purpose which has been involved in Phase III.

REFRAMING UNDERSTANDING OF ALCOHOL ISSUES

We are currently working with the Steering Committee and key stakeholders to develop the communications strategy.

ESTABLISHING LEAD ORGANIZATION(S) AND BUILDING STRATEGIC ALLIANCES

Lead organization(s):

The Centre for Drug & Alcohol Studies, Queensland, is currently being formed. A draft charter has been written and support from local, state and federal governments has been sought. The Centre will have three units: Alcohol & Drug Service, Prince Charles Hospital & District Health Service, Royal Brisbane Hospital Alcohol & Drug Service, and the Department of Psychiatry, University of Queensland.

Building Strategic Alliances:

We have a steering committee of researchers who will be involved in developing the design and methods of the project and will be negotiating smaller steering committees who will oversee the project at a community or regional level. These will involve the regional alcohol & drug services and other regional community groups.

We are also currently negotiating with Divisions of General Practitioners for their involvement. Professor Saunders is also a member of a number of alcohol & other drug task forces and committees at the local and state government level.

DEMONSTRATION PROJECT(S)

Location(s):

There are a number of possibilities of location. The most likely is the allocation of control and intervention conditions by local government areas. There are approximately 125 LGAs in Queensland which are centres of government and services. Typically each LGA will service 1-10 towns ranging from very small to very large populations. Each LGA has at least one primary care practice, this may be a General medical practice or a community centre with a GP or primary care nurse. Some remote areas are serviced by a visiting medical practitioner (The Flying Doctor Service). Our sampling will exclude the Brisbane (capital city) area – potentially a separate demonstration project will be implemented there.

Projected Start Date:

Late 1999

Projected Completion Date:

December 2003

Design of Project:

The study will be a cluster-randomised trial with communities as the unit of randomisation. Potentially some stratification may occur to account for population, GP numbers, community or government support etc. Intervention sites will receive a systematic, community-supported brief intervention in general practice. Control sites will be assessed but will receive no systematic intervention (although for ethical reasons they will not be prevented from introducing screening or brief intervention if they choose to).

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