Local Alcohol Services Research Articles

Shaping alcohol services to meet patients' needs

This article examines the joint working of nurse practitioners with healthcare assistants (HCAs), and how this can shape services to be patient-centred and relevant to effective care. Nurses and healthcare staff are at the centre of patient care and often are best placed to set up clinics to address emerging patient need. This article examines the nursing and healthcare staff from the alcohol and drug liaison team of an inner London hospital, and how they responded to an emerging need from the patients they were treating. Often, patients who have had an alcohol detoxification in hospital are normally signposted to their local alcohol service. These signposted patients often do not engage with their local alcohol service and come back to hospital with more severe complications of alcohol use. This article shows how this team of HCAs and nurses have re-designed their outpatients clinic to enable these patients to be treated. This has been achieved with largely positive outcomes. The mix of the practitioners has been important to enable this model to work. In summary, nurse practitioners with HCAs can respond and shape services to be efficient for patients. With their shared skills, they can produce a patient-centred interface. This can also bring huge fiscal cost savings. This article is encouraging this approach to be more uniform in the NHS and encourage professionals to consider joint working.

Promoting Alcohol Reduction in Non-Treatment Seeking parents (PAReNTS): a protocol for a pilot feasibility cluster randomised controlled trial of alcohol screening and brief interventions to reduce parental alcohol use disorders in vulnerable families

BackgroundResearch estimates that 30% of children under the age of 16 years in the UK live with at least one parent with an alcohol use disorder (AUD). Parental AUDs are associated with adverse childhood experiences and poorer outcomes for children. The PAReNTS (Promoting Alcohol Reduction in Non-Treatment Seeking parents) trial aims to examine the feasibility and acceptability of a randomised controlled trial of brief alcohol interventions to reduce parental alcohol misuse.MethodsThe cluster randomised controlled trial will be conducted within early help family support and children’s social care services in three local authorities in the North East of England: Newcastle, Durham and North Tyneside. All eligible parents the caseloads of participating practitioners will be screened for an AUD using the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) screening tool by the social care practitioners within routine appointments. All parents who score 5 or more on the AUDIT-C will be invited to participate in the trial. Consenting participants will complete a baseline questionnaire before receiving one of three randomised interventions: (i) healthy lifestyle leaflet (control intervention); (ii) a brief alcohol advice intervention delivered by the social care practitioner plus healthy lifestyle leaflet; (iii) a brief alcohol advice intervention delivered by the social care practitioner, healthy lifestyle leaflet plus a 40-min behaviour change intervention with an optional review session delivered by the local alcohol service. Follow-up data will be collected 6 and 12 months post recruitment. A linked qualitative study will explore participating parent and practitioner views on the acceptability of trial processes and interventions.DiscussionThe PAReNTS trial will provide a robust estimate of recruitment, retention and consent rates in order to inform the design of a future definitive study examining the effectiveness and cost-effectiveness of alcohol screening and brief interventions to reduce parental AUDs within vulnerable families.Trial registrationISRCTN registry ISRCTN60291091; protocol version 2; 17.10.2016

Effectiveness and Cost-effectiveness of Opportunistic Screening and Stepped-care Interventions for Older Alcohol Users in Primary Care.

To compare the clinical effectiveness and cost-effectiveness of a stepped-care intervention versus a minimal intervention for the treatment of older hazardous alcohol users in primary care. Multi-centre, pragmatic RCT, set in Primary Care in UK. Patients aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test were allocated either to 5-min of brief advice or to 'Stepped Care': an initial 20-min of behavioural change counselling, with Step 2 being three sessions of Motivational Enhancement Therapy and Step 3 referral to local alcohol services (progression between each Step being determined by outcomes 1 month after each Step). Outcome measures included average drinks per day, AUDIT-C, alcohol-related problems using the Drinking Problems Index, health-related quality of life using the Short Form 12, costs measured from a NHS/Personal Social Care perspective and estimated health gains in quality adjusted life-years measured assessed EQ-5D. Both groups reduced alcohol consumption at 12 months but the difference between groups was small and not significant. No significant differences were observed between the groups on secondary outcomes. In economic terms stepped care was less costly and more effective than the minimal intervention. Stepped care does not confer an advantage over a minimal intervention in terms of reduction in alcohol use for older hazardous alcohol users in primary care. However, stepped care has a greater probability of being more cost-effective. Current controlled trials ISRCTN52557360. A stepped care approach was compared with brief intervention for older at-risk drinkers attending primary care. While consumption reduced in both groups over 12 months there was no significant difference between the groups. An economic analysis indicated the stepped care which had a greater probability of being more cost-effective than brief intervention.

OC-058 Ambulatory Care Alcohol Detoxification (acad) At Whittington Health: A New Approach !

IntroductionAlcohol-related harm costs NHS £3.5 billion a year. It has become a “top priority” for the NHS. Alcohol Concern reported 1.2 million alcohol-related admissions in 2011/12, an increase of 135%...

An evaluation of a screening and brief intervention pilot project for hazardous and harmful drinkers within the accident and emergency department of Manchester Royal Infirmary

Hazardous and harmful drinkers make up a significant percentage of A and E attendees, and brief interventions have been shown to reduce harm among this particular group. This paper evaluates a pilot project which introduced a screening and brief intervention programme within the A and E department. This project aimed to screen and offer brief interventions to attendees and to refer on to local alcohol services if required.

Implementing an Ideology. A Case Study from Leicestershire, England

In the late 1970s, we established for the county of Leicestershire in England (pop. 850,000) what was then a highly innovative service for problem drinkers. It was based upon a number of core beliefs about the nature of people with alcohol problems and about what would be helpful for them. Most notably it rejected the concept of “alcoholism” and treated the clients (“customers”) at all times as being responsible and therefore able to make decisions about what would be helpful for them. It was a community based tiered service, non-abstinence oriented and client demand led. That system of intervention generated a burgeoning referral rate and there was evidence that compared with neighbouring similar counties, the service may have had a positive impact on the long term morbidity and mortality related to alcohol use. The data available were correlational and incomplete but were encouraging. Changes in the style of provision in the neighbouring counties and administrative and structural changes in health and social services nationally meant that it was not possible to continue the service in its comprehensive form, and tracking changes in the indirect indicators of alcohol problems became unfeasible. The natural experiment was terminated by factors beyond our control. Nonetheless, the service still exists, though in a truncated form. Its presence played a part in the development of the template for local alcohol service provision in Britain.

Using mind mapping techniques for rapid qualitative data analysis in public participation processes.

In a health service environment where timescales for patient participation in service design are short and resources scarce, a balance needs to be achieved between research rigour and the timeliness and utility of the findings of patient participation processes. To develop a pragmatic mind mapping approach to managing the qualitative data from patient participation processes. While this article draws on experience of using mind maps in a variety of participation processes, a single example is used to illustrate the approach. In this example mind maps were created during the course of patient participation focus groups. Two group discussions were also transcribed verbatim to allow comparison of the rapid mind mapping approach with traditional thematic analysis of qualitative data. The illustrative example formed part of a local alcohol service review which included consultation with local alcohol service users, their families and staff groups. The mind mapping approach provided a pleasing graphical format for representing the key themes raised during the focus groups. It helped stimulate and galvanize discussion and keep it on track, enhanced transparency and group ownership of the data analysis process, allowed a rapid dynamic between data collection and feedback, and was considerably faster than traditional methods for the analysis of focus groups, while resulting in similar broad themes. This study suggests that the use of a mind mapping approach to managing qualitative data can provide a pragmatic resolution of the tension between limited resources and quality in patient participation processes.

An alcoholic patient who continues to drink: case outcome

Four weeks ago (7 January BMJ 2006;332: 33) we presented the case of Mr Bond, who has a history of alcoholic cirrhosis and presented with a variceal bleed. He discharged...

Reflections from the GP surgery at the turn of the year

Reflections from the GP surgery at the turn of the year

General Practitioners' Management of Problem Drinkers - attitudes, knowledge and practice

There is evidence that GPs frequently fail to identify problem drinkers and many are ambivalent about treating them. This study investigated GPs' perceptions of the numbers of their patients with alcohol problems; how they diagnose problem drinkers and their knowledge and attitudes; GPs' perceived roles and part in management. Fifty GPs were interviewed. Reported rates of detection and treatment of problem drinkers were lower than expected, and referral was the most popular management strategy. Screening occurred most frequently at registration or was opportunistic. When characterizing and diagnosing alcohol misuse, GPs emphasized social rather than health or psychological problems. They found it easier to broach the subject of alcohol misuse when there was objective evidence of damage to health. Knowledge of the local alcohol services was good. Although most considered general practice an appropriate place to treat problem drinkers and nearly all believed it was legitimate to inquire about patients' drinking, 70% said they would like more training. Most of the GPs found work with problem drinkers unrewarding, and 40% admitted to not liking drinkers. Complaints of lack of time were frequent. These findings indicate little change since the late 1980s. More GPs appear to be screening patients for problem drinking, but few are themselves treating those identified. GPs need more training and support to manage these patients in general practice but a more realistic appraisal may be required of what GPs themselves can provide.

Thoughts on 'alcohol problems into the next century'.

Since alcohol misuse is responsible for a good deal of physical as well as social harm in Britain, doctors should receive proper education and training about alcohol. We should approach the 21st century with this and the following goals in mind. The ability to take a drinking history in the majority of patients should be a first priority. This can be done in a few minutes. Doctors should be alert to the many ways in which misuse causes problems that are potentially reversible, rather than concentrating on serious physical harm and dependency. They should be able to undertake brief intervention in heavy drinkers, a valuable tool in both primary care and hospital practice. They should understand the value of community detoxification in patients with withdrawal symptoms; they need to foster links with local alcohol services which have the expertise to help with patients (and their families) who require further supervision. A less pessimistic attitude among doctors to the treatment of alcohol problems needs to be encouraged. The current development of drugs which reduce craving could well provide the means of treating even the most severely affected patients.