Alcohol Brief Interventions
in 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
2003
2005
2007
2008
2009
National Alcohol Team set up at ISD
SIGN 74 and HTA published
Public health principle enshrined in new Licensing Act
ABIs in Enhanced Service Programme
SHAAP manifesto
SHAAP report Price, Policy and Public Health
H4:HEAT target for alcohol brief interventions
(149,449 ABIs by 2011)
£85 million extra funding
SG Alcohol Framework consultation
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)…
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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
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• 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)
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• 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)
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• 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)
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• 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