Alcohol Brief Interventionsin Scotland: Research & Evaluation Andrew McAuley Public Health Adviser (Substance Misuse / Alcohol) NHS Health Scotland INEBRIA, 8th October 2009
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Key Milestones 2003 National Alcohol Team set up at ISD 2003 SIGN 74 and HTA published 2005 Public health principle enshrined in new Licensing Act 2007 ABIs in Enhanced Service Programme SHAAP manifesto SHAAP report Price, Policy and Public Health 2008 H4:HEAT target for alcohol brief interventions (149,449 ABIs by 2011) £85 million extra funding SG Alcohol Framework consultation 2009 SG Alcohol Framework launched
Evaluating alcohol policy in Scotland • Process • Monitoring and Evaluation Reference Group for Alcohol (MERGA), established June 2008. Input from research, policy and national and local delivery partners. • Logic models to identify outcomes and develop evaluation framework. • Portfolio of peer reviewed studies. • From implementation of specific actions (focus on learning) to cumulative outcomes.
Study 2: Alcohol brief interventions Have alcohol brief interventions been delivered as intended and in way likely to make a difference across Scotland? To what extent are the key ingredients being delivered in a way that has been shown to work? • Study will consist of a number of components using quantitative and qualitative data likely to include:- • Models of organisation and care, adoption (by staff) and reach (to potential beneficiaries) • Variations in implementation • Uptake rates by Health Boards over time • Practitioners interpretations and attitudes • Barriers and facilitators • Patient experience • Health Scotland evaluation of training already underway
HEAT: H4 – early findings • Implementation varied in terms of organisation and delivery • Organisation e.g. payments – how much and for what • Delivery e.g. who screened and who given ABI. Variation of proportion screening positive from 14-79% • Onward referral e.g. number of potentially dependent drinkers detected at screening varying considerably between health boards areas • Good progress to date…26,499 (approx. 100% of yr 1 target) ABIs delivered in year 1.
Extending the Evidence Base • Changing Scotland's Relationship with Alcohol: A Framework for Action (SG, 2009) • Potential of ABI effectiveness in a range of other settings (Raistrick et al, 2006)… • Criminal Justice • Sexual Health • Dentistry • Secondary Care • NHS24
Criminal Justice • Identified as a potential setting where they can be effective (NTA; AEG; NPS; Roberts et al) • DoH SIPS Project http://www.sips.iop.kcl.ac.uk/cjs.php _________________________________________________ • A pilot-study to determine the feasibility and effectiveness of delivering screening and ABI (intervention) vs. screening and leaflet only (control) in the community justice settings of probation and community service between Sept. 2009 and March 2011.
Sexual Health • Links between alcohol overuse and sexual health problems • Unsafe sex an indicator of possible hazardous drinking (SIGN74) • Hazardous drinking is very common among Sexual Health clinic attendees, especially under 30s (Standerwick et al, 2007) • Need for more evaluative research on brief interventions with women [and] younger people (Kaner et al, 2007) _____________________________________________________ • RCT to assess the effectiveness of brief interventions delivered in GUM (Aberdeen) and Family Planning clinics (Glasgow)
Dentistry • High prevalence of hazardous/hamrful drinkers present to dental services (Miller et al, 2006; Goodall et al, 2007) • Dental patients approve of dentists asking them about their alcohol use and supporting them to change (Miller et al, 2006; Goodall et al, 2007) ___________________________________________________ • Feasibility project to pilot a training and delivery approach for ABIs within dentistry being undertaken by Glasgow Dental Hospital with support from HS… • Phase 1 (2009/10): Information gathering & needs assessment • Phase 2 (2010/11): Training and resource development • Phase 3 (2010/11): pilot delivery of model
Secondary Care • Further research is required to prove the benefits of brief interventions within general hospital, Cochrane systematic review ‘Brief interventions for heavy alcohol users admitted to general hospital wards’ found evidence for their effectiveness to be ‘inconclusive’ (McQueen et al, 2009) _____________________________________________________ • RCT to assess the effectiveness of brief interventions delivered to inpatients (via occupational therapists) aged 18-80 years admitted to the medical and surgical wards (Glasgow)
NHS24 • Delivery of brief interventions through NHS24 - ‘Taking Measures’ telephone service • Individuals signposted to service following screening by a health professional in Primary Care and/or A & E • Service to be piloted in 2 NHS Board areas to refine delivery model • Service development audit to be carried out • Support materials for professionals and service users produced • Additional support available through NHS24 website
Summary • National embracement of screening and ABI as a health improvement intervention • Positive progress toward HEAT:H4 • Detailed evaluation focussing on implementation • Additional projects aimed at expanding the evidence base • Numerous pilot schemes underway/in development
Any questions? Andrew McAuley Public Health Adviser (Substance Misuse / Alcohol) NHS Health Scotland Public Health Science, EfA Team Elphinstone House 65 West Regent Street Glasgow, G2 2AF Tel: 0141 354 2935 (ext: 2935) Fax: 0141 354 2901 www.healthscotland.com