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Top 30 Quality Measures

Relapse Prevention for Alcohol Use Overall Rank: 19
Access to relapse prevention treatments of established efficacy should be facilitated for alcohol dependent patients.
Domain : Patients with Comorbid Conditions
A condition in which a person has both a major mental illness and another health problem (e.g., development disability, substance abuse, personality disorder, or other general medical conditions such as heart disease or cancer).
Additional Domain(s) : Accessibility, Patients with Substance Abuse
Rationale
Specialist services are effective for relapse prevention if offering behavioural self control training, motivational enhancement therapy, family therapy/community reinforcement approach and/or coping/communication skills training
The GPs decision where to refer a patient should be guided in large part by the patients choice. Some predictors however, have emerged: patients who are angry at the initial assessment appear to do better, in the short term, if given motivational interviewing
Patients with psychiatric disorders (dual diagnosis) tend to do better if referred to specialist psychological or psychiatric services than to 12-step Alcoholics Anonymous (AA) groups. Patients referred to specialist care, who live or work in environments where there is a lot of drinking and little support for abstinence, may do better in a service which offers consultations which emphasize the 12-step AA approach, rather than specialized psychological therapy.
One underpowered study found no advantage to specialist treatment over general practice management in the UK. Two North American studies have shown that milder alcohol dependence can sometimes be successfully managed without specialist care. However, brief primary care intervention has usually excluded alcohol dependent patients who should, in general, be referred for specialist care.
Primary Reference
Drummond DC, Thom B, Brown C, Edwards G, Mullan MJ. Specialist versus general practitioner treatment of problem drinkers.
Lancet. 1990 Oct 13;336(8720):915-8.
PMID: 1976937
Level of Evidence
I: Consistently higher quality studies specifically focused on primary mental health care.

Summarized CommentsAdd Comment
  • PH doesn’t control access - but we can and do certainly refer patients to these services
  • Good idea but not easily put into practice or easily measured
  • Relapse prevention indentification is a key PHC role.
Variation in Results
Ratings-based Rank
Relevance 9
Actionability 33
Overall Importance 21
 
Stakeholder Rank
Academics 26
Clinicians 6
Consumers 23
Decision Makers 30
 
Special Group Rank
First Nations 48
Rural Areas 41
Federal Stakeholders 60
Regional Rank
BC AB SK MB ON QC NB NS PE NL YT NT NU
27 21 12 28 41 21 5 5 5 95 20 47 105
 
Overall Rank

      

19


SA08g (B264)

 
Distribution of Survey Respondent Ratings
Relevance
100
90
80
70
60
50
40
30
20
10
0
0.53 0.53 0 0 1.24 1.6 15.63 48.73 31.72
1 2 3 4 5 6 7 8 9
Low High
Actionability
100
90
80
70
60
50
40
30
20
10
0
0.53 0.53 1.25 2.03 6.98 6.5 22.7 37.75 21.72
1 2 3 4 5 6 7 8 9
Low High
Overall Importance
100
90
80
70
60
50
40
30
20
10
0
1.95 14.54 83.51
3 2 1

3 = can live without
2 = nice to have
1 = indispensable

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The views expressed herein do not necessarily represent the official policies of Health Canada