Addiction medicine 1
Track 6
| Saturday, October 28, 2023 |
| 2:00 PM - 3:15 PM |
| Meeting Room C2.4 |
Speaker
Dr Marguerite Tracy
Senior Lecturer General Practice Clinical School
The University of Sydney
Chairperson
Biography
E/Prof Sean Haley
City University of New York's Graduate School of Public Health and Health Policy
Comparison of perceived alcohol screening barriers and practices between primary care training participants and controls in Rio de Janeiro, Brasil
2:00 PM - 2:15 PMSummary
Background
Screening and brief intervention for harmful alcohol use in primary care reduces alcohol consumption but is rarely used in Brazil. Trainings on alcohol screening and brief intervention were offered to upper-level primary care professionals across two regional service areas within Rio de Janeiro’s universal health care system (Sistema Único de Saúde) between November 2018 and February 2019.
Methods
Training was offered to upper-level professionals (e.g., those with a baccalaureate including physicians, nurses) using the World Health Organization’s Mental Health Gap Action Program’s field training manual. A modified Saitz (2002) instrument assessed providers’ perception of alcohol screening and the AIMS Centers’ Patient Centered Integrated Behavioral Health Care Principles assessed medical and mental health/substance use integration. Both instruments were administered to training participants and controls at the initiation of training and re-administered to trained participants approximately three months after training. Saitz responses were analyzed using Chi Square and McNemar's test. AIMS responses were analyzed using independent samples t-test for baseline (participants vs control) responses and pre-post-paired t-test for the follow up of trained participants.
Results
One hundred and one training participants and 102 controls completed the Saitz instrument and 99 training participants and 100 controls completed the AIMS at baseline`. Sixty-three trained participants completed both instruments. AIMS baseline results suggest trained participants had significantly higher scores on component measures related to screening with a valid instrument, intervention, and care coordination. Few (n=3) Saitz responses differed at baseline (lack of experience, assessing behavior change, confidence providing an alcohol diagnosis), and trained participants expressed significantly lower barrier concerns, significantly greater changes in alcohol screening practices, and statistically greater average confidence at follow-up.
Conclusion
Alcohol screening and brief intervention training using the WHO’s Mental Health Gap Action Program can reduce perceived barriers to alcohol screening and treatment among upper-level primary care professionals in Brazil.
Screening and brief intervention for harmful alcohol use in primary care reduces alcohol consumption but is rarely used in Brazil. Trainings on alcohol screening and brief intervention were offered to upper-level primary care professionals across two regional service areas within Rio de Janeiro’s universal health care system (Sistema Único de Saúde) between November 2018 and February 2019.
Methods
Training was offered to upper-level professionals (e.g., those with a baccalaureate including physicians, nurses) using the World Health Organization’s Mental Health Gap Action Program’s field training manual. A modified Saitz (2002) instrument assessed providers’ perception of alcohol screening and the AIMS Centers’ Patient Centered Integrated Behavioral Health Care Principles assessed medical and mental health/substance use integration. Both instruments were administered to training participants and controls at the initiation of training and re-administered to trained participants approximately three months after training. Saitz responses were analyzed using Chi Square and McNemar's test. AIMS responses were analyzed using independent samples t-test for baseline (participants vs control) responses and pre-post-paired t-test for the follow up of trained participants.
Results
One hundred and one training participants and 102 controls completed the Saitz instrument and 99 training participants and 100 controls completed the AIMS at baseline`. Sixty-three trained participants completed both instruments. AIMS baseline results suggest trained participants had significantly higher scores on component measures related to screening with a valid instrument, intervention, and care coordination. Few (n=3) Saitz responses differed at baseline (lack of experience, assessing behavior change, confidence providing an alcohol diagnosis), and trained participants expressed significantly lower barrier concerns, significantly greater changes in alcohol screening practices, and statistically greater average confidence at follow-up.
Conclusion
Alcohol screening and brief intervention training using the WHO’s Mental Health Gap Action Program can reduce perceived barriers to alcohol screening and treatment among upper-level primary care professionals in Brazil.
Takeaways
Describe alcohol screening, brief intervention and referral to treatment strategies and barriers in primary care
Compare how perceptions of alcohol screening readiness and capacity may differ by professional role/title
Formulate implementation strategies within their own primary care facilities
Compare how perceptions of alcohol screening readiness and capacity may differ by professional role/title
Formulate implementation strategies within their own primary care facilities
Biography
Dr. Haley explores implementation and policy factors associated with substance use disorder prevention and treatment access. Dr. Haley has held leadership and management positions in county and state government systems, foundations, and other not for profit organizations. Dr. Haley completed his post doctorate training as a Policy Research Scientist at the Treatment Research Institute in Philadelphia and served as the Senior Research Analyst for the National Association of State Alcohol and Drug Abuse Directors in Washington, D.C. before joining the faculty of the CUNY Graduate School of Public Health in 2010. Dr. Haley spent the 2018-2019 academic year as a Fulbright Scholar leading an implementation study on alcohol screening and brief intervention in primary care within Rio de Janeiro’s public health care system. He has served as the Chair for the Alcohol, Tobacco, and Other Drug Section of the American Public Health Association, and in June of 2020 he co-founded the national Alcohol Action Network to reduce the rapid expansion of alcohol availability. Dr. Haley serves on the core advisory team for CDC’s Center for Advancing Alcohol Science to Practice.
Dr Paul Grinzi
GP / Medical Educator
Racgp
Tearing Down Barriers to Care - Evaluation of a Home Telehealth Alcohol Withdrawal Service
2:15 PM - 2:30 PMSummary
Background
Clean Slate Clinic is a social enterprise with a mission to demolish stigma, geographical and financial barriers to accessing alcohol and other drug treatments. It has done this by developing a model of home alcohol and other drug withdrawal delivered entirely through telehealth. The University of Sydney have evaluated the model.
Objectives
To study the model’s adoptability, acceptability and effectiveness.
Secondary objectives include evaluating socio-demographics, Severity of Alcohol Dependence (SADQ) scores and co-morbidities.
Methods
81 participants were screened for a prospective 28-day observational study conducted over a 12-month period. 50 people completed detox. Exclusion criteria included history of seizures, complex co-morbidities, suicide or family violence risk, lack of support person or secure housing. Outcomes were retrieved from clinic documentation and questionnaires.
Findings
Participants who completed the 3-month follow-up questionnaire were highly satisfied (n=7) with the service. At 1-month post detox 84% (42) of clients were “Meeting Alcohol Goals”, 14% (7) had “Reduced Alcohol Dependence” and 2% (1) had relapsed. The mean number of standard drinks consumed weekly decreased from 76 at baseline to 5 at 1-month post-detox, 19 at 3 months and 24 at 6 months. Kessler Psychological Distress (K10) scores ranged from 24.61 (high psychological distress) at baseline to 16 (moderate psychological distress) at 1-month post-detox and 15.71 at 3-months post-detox. There were no adverse events reported.
Conclusions
The telehealth model of service delivery has been evaluated as highly adoptable and acceptable. Results indicate that the Clean Slate Clinic is a feasible model for enabling participants to achieve their goals (84%), substantially reducing alcohol intake and reducing psychological distress.
Clean Slate Clinic is a social enterprise with a mission to demolish stigma, geographical and financial barriers to accessing alcohol and other drug treatments. It has done this by developing a model of home alcohol and other drug withdrawal delivered entirely through telehealth. The University of Sydney have evaluated the model.
Objectives
To study the model’s adoptability, acceptability and effectiveness.
Secondary objectives include evaluating socio-demographics, Severity of Alcohol Dependence (SADQ) scores and co-morbidities.
Methods
81 participants were screened for a prospective 28-day observational study conducted over a 12-month period. 50 people completed detox. Exclusion criteria included history of seizures, complex co-morbidities, suicide or family violence risk, lack of support person or secure housing. Outcomes were retrieved from clinic documentation and questionnaires.
Findings
Participants who completed the 3-month follow-up questionnaire were highly satisfied (n=7) with the service. At 1-month post detox 84% (42) of clients were “Meeting Alcohol Goals”, 14% (7) had “Reduced Alcohol Dependence” and 2% (1) had relapsed. The mean number of standard drinks consumed weekly decreased from 76 at baseline to 5 at 1-month post-detox, 19 at 3 months and 24 at 6 months. Kessler Psychological Distress (K10) scores ranged from 24.61 (high psychological distress) at baseline to 16 (moderate psychological distress) at 1-month post-detox and 15.71 at 3-months post-detox. There were no adverse events reported.
Conclusions
The telehealth model of service delivery has been evaluated as highly adoptable and acceptable. Results indicate that the Clean Slate Clinic is a feasible model for enabling participants to achieve their goals (84%), substantially reducing alcohol intake and reducing psychological distress.
Takeaways
Delivery of alcohol detox via telehealth is highly adoptable and acceptable
Delivery of a well-designed package of care for alcohol withdrawal and recovery drives high efficacy
A telehealth model of alcohol withdrawal and recovery can be highly effective
Delivery of a well-designed package of care for alcohol withdrawal and recovery drives high efficacy
A telehealth model of alcohol withdrawal and recovery can be highly effective
Biography
Dr Chris Davis is a GP and Addictions Consultant working at St Vincent's Hospital, Sydney.
He is the Chief Medical Officer and co-founder of the Clean Slate Clinic - a social enterprise
with the mission of reducing health inequality and improving access to alcohol and other drug
treatment. The Clean Slate team use a telehealth platform to deliver withdrawal and recovery
services to patients in their own homes breaking down both geographical and financial barriers
to accessing care.
Dr Marguerite Tracy
Senior Lecturer General Practice Clinical School
The University of Sydney
‘It's a fragile open door’ – Enhancing COVID-19 vaccination rates in people receiving treatment for substance use disorder
2:30 PM - 2:45 PMSummary
Background:
People with substance use disorder (SUD) frequently have physical health co-morbidities such as hepatic and cardiovascular disease and are at high risk of harms from COVID-19 infection. However, several studies have shown that many people with SUD are less likely to be vaccinated for COVID-19 for reasons such as poor vaccine access, and lack of trust in the health system and/or vaccines. Vaccine hesitancy is common in this population and compounds the barriers already experienced by this group to accessing health care. Drug Health Services in Western Sydney developed a model of care to enhance COVID-19 vaccine uptake commencing 22 March 2021.
Objectives:
This study sought to retrospectively evaluate vaccine uptake within the service and explore staff perceptions of strategies employed during the COVID19 pandemic.
Methods:
This study used mixed methods: a retrospective audit of COVID-19 vaccination rates in people accessing care and semi-structured interviews with staff who delivered vaccination interventions.
Findings:
Of the 984 patients that were engaged with the opioid treatment program on 9 December 2021, 90.9% had received the first COVID vaccination and 86.7% the second. Australia wide vaccination rates on that date were 93.1% and 88.7% for first and second doses respectively.
Interview participants commented that having a deep knowledge, understanding and connection with the patient group drove implementation and success of vaccination interventions. This was further supported by communication and sharing information, both among staff and with patients, as well as staff engagement with the vaccination interventions.
Conclusions:
Extensive collaboration across Drug Health Services, and with the local public health unit, assisted overcoming logistical barriers to vaccination. Engaged staff providing information and facilitating access to healthcare underpin this success. High rates of COVID-19 vaccination can be achieved in a vulnerable population.
People with substance use disorder (SUD) frequently have physical health co-morbidities such as hepatic and cardiovascular disease and are at high risk of harms from COVID-19 infection. However, several studies have shown that many people with SUD are less likely to be vaccinated for COVID-19 for reasons such as poor vaccine access, and lack of trust in the health system and/or vaccines. Vaccine hesitancy is common in this population and compounds the barriers already experienced by this group to accessing health care. Drug Health Services in Western Sydney developed a model of care to enhance COVID-19 vaccine uptake commencing 22 March 2021.
Objectives:
This study sought to retrospectively evaluate vaccine uptake within the service and explore staff perceptions of strategies employed during the COVID19 pandemic.
Methods:
This study used mixed methods: a retrospective audit of COVID-19 vaccination rates in people accessing care and semi-structured interviews with staff who delivered vaccination interventions.
Findings:
Of the 984 patients that were engaged with the opioid treatment program on 9 December 2021, 90.9% had received the first COVID vaccination and 86.7% the second. Australia wide vaccination rates on that date were 93.1% and 88.7% for first and second doses respectively.
Interview participants commented that having a deep knowledge, understanding and connection with the patient group drove implementation and success of vaccination interventions. This was further supported by communication and sharing information, both among staff and with patients, as well as staff engagement with the vaccination interventions.
Conclusions:
Extensive collaboration across Drug Health Services, and with the local public health unit, assisted overcoming logistical barriers to vaccination. Engaged staff providing information and facilitating access to healthcare underpin this success. High rates of COVID-19 vaccination can be achieved in a vulnerable population.
Takeaways
1. Having a deep knowledge, understanding and connection with a patient group facilitates patient centred communication
2. When staff are informed and engaged in a project results can be impressive
3. Targeted, person centred programs can overcome barriers such as mis- and dis-information to ensure equitable COVID-19 vaccination rates in vulnerable populations
2. When staff are informed and engaged in a project results can be impressive
3. Targeted, person centred programs can overcome barriers such as mis- and dis-information to ensure equitable COVID-19 vaccination rates in vulnerable populations
Biography
Marguerite Tracy is a senior lecturer with the General Practice Clinical School at the University of Sydney with a twenty year background in clinical general practice. Her current clinical work is at the Centre for Addiction Medicine in Western Sydney Local Health District Drug Health Services. Her interests are in Aboriginal and Torres Strait Islander peoples’ health, addiction medicine, medical education and person-centred health care. Working with Professor Lyndal Trevena and Dr Heather Shepherd Marguerite recently completed her PhD investigating question prompt list tools designed to facilitate patient question asking as part of shared decision making. Marguerite is also a member of the Royal Australian College of General Practitioners Expert Committee - Quality Care.
Dr Paul Grinzi
GP / Medical Educator
Racgp
By GPs for GPs: Designing a successful Australian Alcohol and Other Drugs Continuing Professional Development Program
2:45 PM - 2:50 PMSummary
Aim: To describe the key components for designing best practice GP continuing professional development education, drawing upon evidence from the Royal Australian College of General Practitioners (RACGP) Alcohol and Other Drugs (AOD) GP education program evaluation.
Content: This rapid impact presentation will describe the design and delivery elements of the RACGP AOD GP education program that led to its success.
Description of the program design will cover its:
- content development and rationale, for example, the inclusion of the 5A’s framework and transtheoretical (stages of change) model for behavioural change.
- educational options available to participants: online, self-directed/asynchronous; online, live; videoconference case discussions and mentor-assisted training.
- the key components of best-practice CPD program design identified through the AOD program including: peer delivery (“by GPs for GPs”); offering remuneration, flexibility and empowerment; offering opportunities to connect with colleagues.
- the by ‘GPs for GPs’ design utilises a humanistic and strengths-based approach that is universal and able to be applied internationally.
The presentation will share links to:
1) an open access AOD resource library, which contains education opportunities to develop AOD skills. It also contains resources, guidelines, and tools that can be used within clinics to support GP-led AOD care.
2) and the Program’s publications, including a formal evaluation report
This presentation will be engaging for all attendees as it relates to strategies to advance workforce capacity and competence, in addition to sharing practical clinical and educational resources.
Goals:
To describe the key components for designing best practice GP continuing professional development education.
To describe evidence from the RACGP alcohol and other drugs (AOD) GP education program evaluation.
Inspires attendees to develop and/or engage in continuing professional development for complex challenges, such as facilitating behavioural change for AOD use.
Content: This rapid impact presentation will describe the design and delivery elements of the RACGP AOD GP education program that led to its success.
Description of the program design will cover its:
- content development and rationale, for example, the inclusion of the 5A’s framework and transtheoretical (stages of change) model for behavioural change.
- educational options available to participants: online, self-directed/asynchronous; online, live; videoconference case discussions and mentor-assisted training.
- the key components of best-practice CPD program design identified through the AOD program including: peer delivery (“by GPs for GPs”); offering remuneration, flexibility and empowerment; offering opportunities to connect with colleagues.
- the by ‘GPs for GPs’ design utilises a humanistic and strengths-based approach that is universal and able to be applied internationally.
The presentation will share links to:
1) an open access AOD resource library, which contains education opportunities to develop AOD skills. It also contains resources, guidelines, and tools that can be used within clinics to support GP-led AOD care.
2) and the Program’s publications, including a formal evaluation report
This presentation will be engaging for all attendees as it relates to strategies to advance workforce capacity and competence, in addition to sharing practical clinical and educational resources.
Goals:
To describe the key components for designing best practice GP continuing professional development education.
To describe evidence from the RACGP alcohol and other drugs (AOD) GP education program evaluation.
Inspires attendees to develop and/or engage in continuing professional development for complex challenges, such as facilitating behavioural change for AOD use.
Takeaways
At the conclusion of this presentation, attendees will take away
Identify resources and education opportunities to assist with GP-led AOD care.
Identify and develop strategies to deliver best-practice GP education, mentoring and/or supervision.
Have new ideas that can inform the planning of strategies to advance workforce capacity and competence to facilitate behavioural change among patients using AOD.
Identify resources and education opportunities to assist with GP-led AOD care.
Identify and develop strategies to deliver best-practice GP education, mentoring and/or supervision.
Have new ideas that can inform the planning of strategies to advance workforce capacity and competence to facilitate behavioural change among patients using AOD.
Biography
Dr Paul Grinzi is specialist general practitioner who combines a clinical workload with numerous medical education roles. Clincally, Paul has incorporated an interest in addiction medicine within his general practice, including working with those patients with chronic pain and other common comorbid conditions.
Paul is also part of the Royal College of General Practitioners' Special Interest Addiction Network, Victorian Alcohol and Other Drug Committee and he was also the lead educator for the RACGP's national AOD Education program. In addition to his clinical and advocacy work, he also works as a medical educator utilising his experience to focus upon educating fellow GPs in various addiction topics.
Outside of work, he enjoys witnessing his two boys grow up and the adventure this entails.
Supa Oh
The association between cotinine-measured smoking intensity and sleep quality
2:50 PM - 2:55 PMSummary
Aim: Cigarette smoking is suggested to be associated with sleep problems. This study evaluated the quantitative association between urinary cotinine-verified smoking intensity and sleep quality assessed by the Pittsburgh Sleep Quality Index(PSQI).
METHODS: This was a cross-sectional study of 189970 participants from the Kangbuk Samsung Health Study recruited between 2016 and 2018. Logistic regression analysis adjusted for covariates was performed to estimate the association between urinary cotinine levels assessed by quartiles and poor sleep quality, defined as global PSQI score >5.
RESULTS: The odds ratios (OR) and 95% confidence intervals (CI) for poor sleep quality comparing the highest urinary cotinine quartile to non-smokers were: 1.23(95% CI: 1.16–1.30) for overall, 1.19 (95% CI: 1.12–1.26) for males, and 1.55(95% CI: 1.29–1.87) for females. Among self-reported never smokers, cotinine-verified smokers had higher odds for decreased sleep quality compared to cotinine-verified never smokers with OR of 1.26 (95% CI: 1.08–1.46).
CONCLUSIONS: Elevated urinary cotinine levels were associated with poor sleep quality in relatively young and middle-aged South Korean adults. Higher odds for poor sleep quality among cotinine-verified smokers who self-reported as never smokers also demonstrate the value of quantitative measurement of urinary cotinine.
Prospective studies are warranted to clarify the cause-effect relationship between smoking and sleep quality.
METHODS: This was a cross-sectional study of 189970 participants from the Kangbuk Samsung Health Study recruited between 2016 and 2018. Logistic regression analysis adjusted for covariates was performed to estimate the association between urinary cotinine levels assessed by quartiles and poor sleep quality, defined as global PSQI score >5.
RESULTS: The odds ratios (OR) and 95% confidence intervals (CI) for poor sleep quality comparing the highest urinary cotinine quartile to non-smokers were: 1.23(95% CI: 1.16–1.30) for overall, 1.19 (95% CI: 1.12–1.26) for males, and 1.55(95% CI: 1.29–1.87) for females. Among self-reported never smokers, cotinine-verified smokers had higher odds for decreased sleep quality compared to cotinine-verified never smokers with OR of 1.26 (95% CI: 1.08–1.46).
CONCLUSIONS: Elevated urinary cotinine levels were associated with poor sleep quality in relatively young and middle-aged South Korean adults. Higher odds for poor sleep quality among cotinine-verified smokers who self-reported as never smokers also demonstrate the value of quantitative measurement of urinary cotinine.
Prospective studies are warranted to clarify the cause-effect relationship between smoking and sleep quality.
Takeaways
1.Smoking is associated with sleep quality.
2. Higher odds for poor sleep quality among cotinine-verified smokers who self-reported as never smokers also demonstrate the value of quantitative measurement of urinary cotinine.
2. Higher odds for poor sleep quality among cotinine-verified smokers who self-reported as never smokers also demonstrate the value of quantitative measurement of urinary cotinine.
Biography
Jae-Heon Kang is a professor of medicine in Sungkyunkwan University, College of Medicine. He graduated from Seoul National University College of Medicine. And he received his M. D. degree, Master of Public Health degree on epidemiology and Ph.D on preventive medicine from Seoul National University, College of Medicine. His previous positions include: director of the Obesity Center of Inje University Paik Hospital since 1997, chairman of the Obesity Research Institute since 2003 and chairman of the Department of Family Medicine at Seoul-Paik hospital since 2004. He was also a visiting professor of Human Nutrition Unit in University of Sydney in 2001.
His current positions include: a professor of medicine in Sungkyunkwan University, College of Medicine, the chairman of Institute for Clinical Nutrition, and the chairman of Institute for Innovative Healthcare.
He is currently the director for the “Leading University Project for International Cooperation in Sri Lanka’ as well. And He was elected as the chairman of Korean Academy of Family Medicine and will serve for two years starting in 2024.
