Transcript Alcohol policy: research and practice

Alcohol Screening and Brief Intervention
Research Programme
national brief intervention research consortium
Paolo Deluca, PhD
Institute of Psychiatry
King’s College London
A&E St. Mary’s
'Scientia Vincit
Timorem'
Programme design
• 3 cluster randomised clinical trials (PHC, AED,
CJS) to assess
– What are the barriers/facilitators to
implementation in a “typical setting”
– Identify most effective screening approach/tool
– Most effective and cost effective intervention
approach
• Common measures and design to allow
comparisons
PHC study
• 24 PHC practices, 3 regions (NE, London, SE)
• 4 screening approaches (universal vs targeted, M-SASQ vs FAST)
Targeted: New registrations, Injuries, Hypertension,
Gastrointestinal problems, Mental health problems
• 3 intervention approaches
– Patient information leaflet (DH - How much is too much?)
– Brief advice (5 min)
– Brief Lifestyle Counselling (20 min)
• 744 patients (31 each)
• Incentives (research, clinical)
• Baseline research interview
• 6 & 12 month follow-up research interview
• Attitudes, barriers and facilitators
PHC Research progress update
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Recruited 24 (+8) practices
Trained 189 staff (nurses and GPs)
Recruiting participants since May 08
497 (66.8%)
6 GPs completed recruitment, 9 about to end
7 under performing and 2 dropped out
2 agreed to carry on
Approached Eligible
PHC
2280
%
Screened Positive Consented
1858
1858
532
444
81.5
81.5
28.6
83.5
Training PHC staff
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On site training to small groups delivered by RA & AHW
1 to 2 hrs for screening and BA including role play
1 to 2 sessions for BLC training with actors in PHC
Overall positive feedback on training
Research elements and Alcohol Units are usually the
challenging parts of the training
• Most welcomed receiving training and being assessed
• 1 session with actor was enough for all but one practice
• But adequate space, staff availability, time and
implementation issues slowed the training stage
PHC Implementation issues
• Protocol: Leaflet-eligibility-screening-informed
consent-baseline-intervention
• Ideally delivered by same person (except BLC)
• In practice we implemented various models to fit
local needs and resources (10 min slots)
• Strong local lead (champion)
• N of staff involved (all vs just a few)
• Low recruitment/positives in same areas (eg
Enfield)
• After good start, patients re-attending slowed
recruitment
AED study
• 9 AEDs, 3 regions (NE, London, SE)
• 3 screening approaches (M-SASQ, PAT, FAST)
• 3 intervention approaches
– Patient information leaflet
– Brief advice (5 min)
– Referral to Alcohol Health Worker BLC (20 min)
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1,179 patients (131 each)
Baseline research interview
6 & 12 month follow-up research interview
Attitudes, barriers and facilitators
A&E Research progress update
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Recruited 9 (+2) A&Es
Trained 250 staff (nurses and consultants)
Recruiting participants since April 08
717 (60.8%)
1 A&E completed recruitment, 3 about to end
All underperforming
Approached Eligible
A&E
3230
%
Screened Positive Consented
2155
2110
788
679
66.7
65.3
37.3
86.2
Training A&E staff
• On site training to small and large groups delivered by
RA & AHW
• 1 to 2 hrs for screening and BA including role play
• No BLC training
• Overall positive feedback on training. Research
elements and Units are usually the challenging parts of
the training
• Most welcomed receiving training
• Adequate space, staff availability, “on call”, turnover,
time and implementation issues slowed training
• Booster sessions, launch events, shadowing staff first
few weeks
A&E Implementation issues
• Protocol: Leaflet-eligibility-screening-informed
consent-baseline-intervention
• Ideally delivered by same person (except BLC) in
practice divided by triage/nurses and doctors
• Strong local lead (champion)
• Consent and contact details put some participants
off
• Workload
• Staff turnover (eg August)
• Easily forget training if start is delayed
• Tendency of targeting dependent drinkers
CJS study
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96 offender managers, 18 offices
3 regions (NE, London, SE)
2 screening tools (FAST, M-SASQ)
3 interventions
– Leaflet
– Brief advice (5 min)
– Brief Lifestyle Counselling by Alcohol Health Worker
• 480 participants (5 each)
• Follow-up 6 & 12 months
• Attitudes, barriers and facilitators
CJS Research progress update
• Recruited 96 (+11) Offender Managers from 18
probation offices
• Trained 131 OMs (some disappeared after training)
• Recruiting participants since June 08
• 151 (31.5%)
• 17 OMs completed recruitment, 10 about to end,
remainder underperforming-struggle to start, 24
dropped out/left
Approached Eligible
CJS
304
%
Screened Positive Consented
250
250
164
141
82.2
82.2
65.6
86.0
Training CJS staff
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On site 1 to 1 training delivered by RA & AHW
1 to 2 hrs for screening and BA including role play
No BLC training
Overall positive feedback on training. Research
elements (informed consent) and ulcohol units are
usually the challenging parts of the training
• Not very enthusiastic, most drawn into it from line
manager.
• Adequate space, staff availability (1to1), turnover,
slowed training
• Booster sessions, shadowing staff first few weeks
CJS Implementation issues
• Protocol: Leaflet-eligibility-screening-informed
consent-baseline-intervention
• Delivered by same person (except BLC)
• No strong local lead (champion)
• Consent and contact details put some participants
off
• Workload
• North/South divide
• Staff not engaging with SIPS team
• Easily forget training if start is delayed
• Weekly support, further incentives?
Training tools and methods
 List of tools
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M-SASQ
FAST
SIPS-PAT
AUDIT
Screening training
PIL
Brief Advice (BA)
BA Training
Brief Life Style
Counselling (BLC)
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BLC training
BLC Demo video
Actors’ scripts
Staff pre-training
questionnaire
– Staff post-training
questionnaire
– BECCI + Manual
– Training manual
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Website
www.sips.iop.kcl.ac.uk & Alcohol Learning Centre
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Training and intervention tools
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Recruitment by month
100
90
80
70
60
50
A&E
PHC
CJS
40
30
A&E Projected
PHC Projected
CJS Projected
20
10
0
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Changes to improve recruitment
• Deployment of our AHWs in A&Es
• Additional GP surgeries to complement the
underperforming ones
• Additional offender managers to complement
the underperforming ones
• Extra support to offender managers
• Allow over-recruitment in CJS and PHC
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Conclusions
• Prevalence of AUDs reflect previous studies in
these settings
• Patients/clients are more willing to receive an
intervention than previous studies
• Overall staff in these settings are keen to be
trained
• However, limited time, workload and turnover
are limiting implementation