SIPS: The Story So Far

Mary Clifford

1

, Stephanie Clutterbuck

1

, Elizabeth Phinn

1

, Rose Cappello

2

, Malcolm Hobbs

2

, Debra Jeffery

2 1

Institute of Health and Society, Newcastle University

2

Institute of Psychiatry, Kings College London

Introduction

Extensive research exists on randomised controlled trials (RCTs) of screening and brief alcohol interventions (SBIs) in health settings. Most trials have reported positive effects of BI in terms of reduced alcohol consumption in increased and high risk drinkers. Despite this, key questions remain including the applicability of the evidence to routine practice, the most efficient strategy for screening patients and the required intensity of BI in primary and secondary care. Furthermore, despite the prevalence of alcohol misuse prevalent amongst offenders, there is limited evidence of alcohol SBI in criminal justice settings (CJS).

The SIPS (Screening and Intervention Programme for Sensible Drinking) research programme is the largest of its kind and has been funded £3.2 million by the Department of Health (DH) as an action under the “Alcohol Harm Reduction Strategy for England” (2004).

The programme, led by Professor Colin Drummond and Professor Eileen Kaner was developed by a team of individuals from Various institutions including King's College London, Newcastle University, Universityof York, St George’s and Alcohol Concern.

Aims

• To conduct a pragmatic factorial cluster RCT of SBI for increased and high risk drinkers across 3 settings.

• To identify: 1. The best screening methods to detect increased and high risk alcohol consumption.

2. The most appropriate brief intervention techniques for people who consume alcohol at increased and high risk levels.

3. The best, most appropriate, most acceptable and most cost effective methods of implementation.

4. Barriers to implementation.

Method

Staff from Accident and Emergency Departments (AED), Primary Health Care (PHC) and Offender Managers (OM) delivered SBI.

Total participants recruited: 2600

Approach

(AED and PHC only) Targeted

Patients presenting with at least one of the following: mental health problems, gastrointestinal problems, hypertension, injuries or new registrations.

Universal

All patients were eligible to participate

Recruitment

Participation was voluntary. Patients/clients were required to meet specific eligibility criteria before written consent was obtained.

Screening Tools

MSASQ (Modified Single Alcohol Screening Question)

A single question screening tool that can be a quick and effective way to screen for alcohol problems in busy settings.

FAST (Fast Alcohol Screening Test)

A 4-item screening test for use in busy clinical settings. Greater than 50% of increased/high risk drinkers are identified by the first question.

PAT (Paddington Alcohol Test) AED only

A targeted screening tool which is applied in cases with presenting conditions commonly associated with alcohol misuse.

A modified version of the PAT was used.

Intervention Tools

Condition 1: PIL- Patient Information Leaflet

The PIL is the DH booklet (2008) “How Much Is Too Much?”, delivered to patient/clients using a standard script to avoid the leaflet resembling brief advice.

Condition 2: BA- Brief Advice (+ PIL)

The 5 minute BA was developed for the SIPS programme based on Simple Structured Advice Intervention Tool (DH). It provides a prompt on which to structure and deliver BA to increased/high risk drinkers.

Condition 3: BLC- Brief Lifestyle Counselling (+ PIL and BA)

The BLC was developed for the SIPS programme and based on Extended Brief Intervention tool (DH). The BLC provides a prompt on which to structure 20 min of brief lifestyle counselling to increased/high risk drinkers.

Follow Up

At 6 and 12 month post intervention participants are contacted to complete a follow up questionnaire.

Outcome Measures

Effectiveness of Intervention

● Extent of screening and intervention activity ● Attitudes and acceptability of SBI implementation ● Impact on service, costs and benefits

Patient Outcome Measures

● Alcohol consumption ● Health-related QoL ● Alcohol related problems ● Health-related and wider societal costs

Where We Are Now

Recruitment has been completed and follow-up interviews are currently being conducted. An interim report will be available for early 2010 with a final report due later that year. Results will address the current evidence gap that exists around SBI in real-life settings and should provide invaluable information to guide further development and implementation of the National Alcohol Harm Reduction Strategy in England.