Transcript Detailed timetable for central input

High Impact Changes
High Impact Changes
• Prioritize alcohol within LAAs and NHS Operating
Framework – Vital Signs
• Improve treatment
• Review pathways and access – NATMS
• Evidence based practice – Models of Care
• Implement IBA
• Health: A&E, Clinics, GPs
• Criminal Justice
• Develop activities to control alcohol misuse
• Identify local champions & build the case for investment
• Provide local implementation of national media
campaigns
Mental Health
1. Treat home based care and support
as the norm
2. Improve access to screening and
assessment
3. Manage variation in service user
discharge processes
4. Manage variation in access to all
mental health services
5. Avoid unnecessary contact
6. Increase the reliability of
interventions
7. Apply a systematic approach
8. Improve service user flow by
removing queues
9. Use an integrated care pathway
approach
10. Retain an effective workforce
Social Care
1) involvement
2) dignity and respect
3) meeting fundamental needs
4) accessible information and
support
5) partnership working
6) personalised services
7) effective commissioning
8) flexibility/challenge/creativity
9) inclusion, and
10) carers as partners in care
Tobacco
Excellence in tobacco control:
10 High Impact Changes to
achieve tobacco control
An evidence-based resource for local
Alliances
Prepared by the Tobacco Control National Support
Team, May 2008
1. Work in partnership
2. Gather and use the full range of data
to inform tobacco control
3. Use tobacco control to tackle health
inequalities
4. Deliver consistent, coherent and coordinated communication
5. An integrated stop smoking approach
6. Build and sustain capacity in tobacco
control
7. Tackle cheap and illicit tobacco
8. Influence change through advocacy
9. Helping young people to be tobacco
free
10. Maintain and promote smoke-free
environments
High Impact Changes
• Prioritize alcohol within LAAs and NHS Operating
Framework – Vital Signs
• Improve treatment
• Review pathways and access – NATMS
• Evidence based practice – Models of Care
• Implement IBA
• Health: A&E, Clinics, GPs
• Criminal Justice
• Develop activities to control alcohol misuse
• Identify local champions & build the case for investment
• Provide local implementation of national media
campaigns
High Impact Changes
• Prioritize alcohol within LAAs and NHS Operating
Framework – Vital Signs
• Improve treatment
• Review pathways and access – NATMS
• Evidence based practice – Models of Care
• Implement IBA
• Health: A&E, Clinics, GPs
• Criminal Justice
• Develop activities to control alcohol misuse
• Identify local champions & build the case for investment
• Provide local implementation of national media
campaigns
Point of Clarification
• Opportunistic alcohol case Identification and the
delivery of Brief Advice (IBA)
is the same as
• Screening and Brief Interventions for alcohol
misuse (SBI)
Evidence for IBA
• There is a very large body of research evidence
• 56 controlled trials (Moyer et al., 2002) all have shown
the value of IBA
• A recent Cochrane Collaboration review (Kaner et al.,
2007) shows substantial evidence for IBA effectiveness
• For every eight people who receive simple alcohol
advice, one will reduce their drinking to within lower-risk
levels (Moyer et al., 2002)
• This compares favourably with smoking where only one
in twenty will act on the advice given (Silagy & Stead,
2003)
– This improves to one in ten with nicotine replacement
therapy.
Benefits of IBA
• IBA would result in the reduction from higher-risk to lower-risk
drinking in 250,000 men and 67,500 women each year (Wallace et
al, 1988).
• Higher risk and increasing risk drinkers who receive brief advice are
twice as likely to moderate their drinking 6 to 12 months after an
intervention when compared to drinkers receiving no intervention
(Wilk et al, 1997).
• Brief advice can reduce weekly drinking by between 13% and 34%,
resulting in 2.9 to 8.7 fewer mean drinks per week with a significant
effect on recommended or safe alcohol use (Whitlock et al, 2004).
• Reductions in alcohol consumption are associated with a significant
dose-dependent lowering of mean systolic and diastolic blood
pressure (Miller et al, 2005).
• Brief advice on alcohol, combined with feedback on CDT levels, can
reduce alcohol use and %CDT in primary care patients being treated
for Type 2 diabetes and hypertension (Fleming et al, 2004).
The Numbers
ENGLAND
PCT
PRACTICE
GP
Total Population
53,588,218
352,554
6,487
1,606
Adult Population
43,580,873
286,716
5,275
1,306
Dependent
drinkers
1,568,911
10,322
190
47
Increased and High
Risk
9,849,277
64,798
1,192
295
FACTS
FIGURES
PCTs
152
Inc + High %
22.6
Dep %
Practices
GPs
3.6
8,261
33,364
IBA in A&E
• A study at St Mary’s Paddington showed that patients
who received an intervention (Crawford et al, 2004):
– Were drinking at significantly lower levels
– Made 0.5 fewer visits to A&E
• A study in Liverpool supports having an alcohol liaison
nurse in A&E working into the hospital. It suggests the
post saved 40 admissions per year - much more than its
cost (Royal College of Physicians, 2001)
Treatment
• Dependent drinkers cost the NHS double the cost of
lower-risk drinkers
• Dependent drinkers represent a very high-risk group for
hospital admissions
• UK Alcohol Treatment Trials (UKATT)
– SBNT & MET
– 25% successful outcome – no alcohol-related
problems
– 40% much improved – reduced problems by 66%