Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention

Objectives To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined. Design A pre-post trial conducted from May 2012 to May 2014. Setting Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia. Participants Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up. Interventions A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Primary and secondary outcome measures Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up. Results Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24%vs 54%, p<0.001), brief advice (26%vs 46%, p<0.001), and clinicians speaking about (10%vs 31%, p<0.001) and arranging a referral (1%vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22%vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care. Conclusion This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed. Trialregistration number ACTRN12614000469617.