What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada

• Main Authors: GC Purcell-Khodr, Kylie Lee, James Conigrave, E Webster, KM Conigrave
• Format: Article in Journal/Newspaper
• Language: unknown
• Published: 2020
• Subjects: Health sciences; Health services and systems; Public health; Indigenous; First Nations; Alcohol; Primary health care; Outpatient; Relapse prevention medicines; Naltrexone; Disulfiram; Culture; Cultural healing; Canada; New Zealand
• Online Access: https://doi.org/10.26181/14498352.v2; https://figshare.com/articles/journal_contribution/What_can_primary_care_services_do_to_help_First_Nations_people_with_unhealthy_alcohol_use_A_systematic_review_Australia_New_Zealand_USA_and_Canada/14498352

Background: First Nations peoples of Australia, New Zealand, the United States of America (USA) and Canada are more likely to be non-drinkers than other people in these countries. However, those who do drink may be at greater risk of alcohol-related harms (at a population level) due to the ongoing impacts from colonisation and associated oppression. Addressing unhealthy drinking (drinking above recommended limits including alcohol use disorders) in primary care settings is one important way to increase accessibility of treatment. Methods: This systematic review identifies peer-reviewed studies of alcohol treatments delivered in primary care or other non-residential settings for First Nations peoples of Australia, New Zealand, USA and Canada. Literature searches were conducted in seven academic databases from their inception until March, 2020. We assessed evidence of treatment or implementation effectiveness, perceived acceptability or accessibility, and the study quality as assessed by the AXIS tool and by a measure of community participation in the research process. Results: Twenty-eight studies were included, published between 1968 and 2018. Studies reported on a range of alcohol treatments, from brief intervention to ambulatory withdrawal management, relapse prevention medicines, and cultural therapies. Brief intervention was the most studied approach. Cultural healing practices and bicultural approaches were a key theme amongst several studies. Four studies measured treatment effectiveness, including one randomised controlled trial (naltrexone vs naltrexone plus sertraline vs placebo) and two uncontrolled trials of disulfiram. Of the six implementation studies, three were (hybrid) effectiveness-implementation designs. Most of the remaining studies (n = 21) focused on treatment accessibility or acceptability. Community participation in the research process was poorly reported in most studies. Conclusions: Research evidence on how best to care for First Nations peoples with unhealthy alcohol use is limited. ...