PubMed · 11636217
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T P Korzhikhina. 1985. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11636217/
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BACKGROUND: In many European countries, medical education on alcohol remains inadequate in terms of both quantity and quality. The expansion of GP training and care protocols would improve the management and outcome of alcoholic patients. Our purpose was to assess the impact of a multifaceted intervention by trained GPs in the management of alcohol-dependent patients. RESULTS AND DISCUSSION: Trained GPs proved better i) in the attempt at abstinence, with 67% patients becoming sober vs. 47% in a comparison sample and ii) in repeat attempt at abstinence in the event of relapse, with an average 2.99 vs. 1.31 attempts per patient. There were no differences in terms of i) relapses, which involved about three in four patients, and ii) prolonged abstinence, which averaged two months. Overall, patients managed by trained GPs remained abstinent 103 days during the 18-month follow-up period vs 68 days for the comparison sample (p = 0.016). METHODS: This 18-month follow-up study had a quasi-experimental design with 24 volunteer trained GPs and a comparison sample of a representative sample of 24 GPs. All GPs included their own already existing DSM-IV alcohol-dependent patients. Patients with depression or anxiety comorbidities were included. Participants were 126 patients in the trained sample and 122 in the comparison sample. The two patient samples were evenly-balanced, averaging 47 years old and 80% males. In the trained sample, consultations were scheduled and management (medication, biological workup) was protocolized, whereas the comparison sample representing standard practice had no obligations. CONCLUSION: Medical education can sharply improve the management of alcohol-dependent patients and short-term outcome. Trained GPs lead more patients to attempt abstinence and more often than in standard practice. However, a strict medical approach remains limited in the maintenance of medium-term abstinence (over two months), providing a strong argument for multidisciplinary management of alcohol-dependent patients.
INTRODUCTION: The Yolngu people of North-east Arnhem Land, Northern Territory, Australia, have lived with alcohol for just over 30 years. For some it has had devastating health, social, family and cultural impacts. This is particularly the case for a group of Yolngu people who permanently or transiently camp on the fringes of the predominately non-Indigenous township of Nhulunbuy. The Miwatj Health Aboriginal Corporation Outreach Program was a response to alcohol use by this Aboriginal community. An evaluation, in consultation with Miwatj Health, sought to examine the conception, development and success of the Outreach Program. METHODS: This was a qualitative study that used: unconcealed participant observation, formal semi-structured interviews, group interviews, opportunistic impromptu discussion, and documentary/archival review. Interviews were conducted with Outreach Program staff, Yolngu community members, Aboriginal health workers, Miwatj Health doctors, Living with Alcohol representatives, the town administrator, Nhulunbuy police sergeant, the publican and local council officer. Group interviews were conducted with two groups of campers, Outreach Program workers and Aboriginal health care workers. DISCUSSION: For the Yolngu people the focus of the Outreach Program was meant to be on talking with and counselling drinkers, cultural activities, and liaising with other substance misuse programs and the police. The Outreach Program has achieved some success and helped a small number of Yolngu to limit their alcohol use and reconnect with the community. However, the Outreach Program has come to focus more and more on cleaning up litter; a key issue for the non-Indigenous community. CONCLUSION: This article focused on one key finding from the evaluation and that is the impact that funding (or lack of funding), the source of funding and the parameters imposed by funding bodies can have on the success or otherwise of a community driven program. The ability of Indigenous communities to determine appropriate program approaches and implementation is undermined when funding sources place restrictions which reflect non-Indigenous values and dominate program outcomes.
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