BACKGROUND Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements. METHODS We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes. RESULTS Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements. CONCLUSION Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).

中文翻译：

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对改善初级卫生保健中不健康饮酒行为的实践、检测和治疗的方法进行系统审查：持续质量改进的作用。


背景技术不健康的饮酒涉及从危险使用（超出指导方针但无害）到酒精依赖的一系列范围。自 1979 年以来，一直建议在初级卫生保健中对不健康饮酒进行循证管理。然而，事实证明，持续、系统的实施具有挑战性。持续质量改进 (CQI) 流程旨在使服务能够检测障碍，然后设计并实施变更，从而实现服务改进。方法 我们对有关改善初级保健中不健康饮酒筛查和干预措施实施策略的文献进行了系统回顾（MEDLINE EMBASE、PsycINFO、CINAHL、澳大利亚土著健康信息网）。其他纳入标准为：(1) 务实的环境； （二）报告原始数据； (3) 与提供服务或实践改变相关的定量结果。我们调查了 CQI 三个基本要素的使用程度（数据引导的活动、考虑当地条件；迭代开发）。我们比较包含这三个元素的程序与不包含这三个元素的程序的特征。我们描述了策略的类型、组织级别（例如卫生服务、实践、临床医生）、策略的持续时间及其结果。结果 收录了代表 45 个项目的 56 篇论文。其中，24 篇论文为随机对照试验，12 篇为对照研究，20 篇为前后及其他设计。大多数报告了改进筛查和简短干预实施的策略。只有六项涉及预防复发的药物疗法。只有五个报告了患者的治疗结果，但没有一个显示出显着的改善。 12 份报告清楚地表明了 CQI 的三个基本要素。 更多涉及三个基本 CQI 要素的研究的实施和随访持续时间高于中位数；采用多方面的设计；针对实践和卫生系统层面；与没有 CQI 要素的研究相比，改进了筛查和简短干预。结论 在实施研究中利用 CQI 方法似乎非常适合推动改善针对不健康饮酒的服务提供。然而，描述此类研究的文献仍然很少。需要更精心设计的研究，包括对实施和患者结果的混合研究，才能就实施不健康饮酒筛查和治疗的最佳方法得出更清晰的结论。 （PROSPERO 注册 ID：CRD42018110475）。