LAUSR

BACKGROUND AND AIMS Unhealthy alcohol consumption is a key concern for Aboriginal and Torres Strait Islander ('Indigenous') communities. It is important to identify and treat at-risk drinkers, to prevent harms to physical or social wellbeing. We aimed to test whether training and support for Aboriginal Community Controlled Health Service (ACCHS) staff would increase rates of alcohol screening and brief intervention. DESIGN Cluster randomised trial SETTING: Australia. CASES Twenty-two ACCHSs that see at least 1,000 clients per year and use Communicare as practice management software. The study included data on 70,419 clients. INTERVENTION Training, regular data feedback, collaborative support, and funding for resources ($9,000). Blinding was not used. Comparator was wait-list control (equal allocation). MEASUREMENT AUDIT-C screening and records of brief interventions were extracted from practice management software at 2-monthly intervals. Observations described the clinical actions taken for clients over each 2-month interval. The Baseline period (28 August 2016 to 28 August 2017) was compared with the post-implementation period (29 August 2017 to 28 August 2018). We used multi-level logistic regression to test the hypotheses that clients attending a service receiving active support would be more likely to be screened with AUDIT-C (primary outcome), or to receive a brief intervention (secondary outcome). FINDINGS We observed an increase in the odds of screening with AUDIT-C for both groups, but the increase was 5.52 (95% CI 4.31, 7.07) times larger at services receiving support. We found little evidence that the support program increased the odds of a recorded brief intervention relative to control services (OR 2.06; 95% CI 0.90, 4.69). Differences in baseline screening activity between treatment and control reduce the certainty of our findings. CONCLUSIONS Providing Aboriginal Community Controlled Health Services with training and support can improve alcohol (AUDIT-C) screening rates.