Title: Nick Heather PhD
1IMPLEMENTING BRIEF INTERVENTIONS IN PRACTICE
RECENT DEVELOPMENTS FROM SOUTH OF THE BORDER
- Nick Heather PhD
- Division of Psychology, Northumbria University
- Presentation at SHAAP One-day Conference,
- Edinburgh, 7/2/08
2DEVELOPMENTS TO BE COVERED
- Cochrane Review of effectiveness of BI
- DH SIPS (Trailblazer) project
- Safe, Sensible, Social (renewed alcohol strategy)
and other DH publications - Roll-out of SBI across England
- NICE project
- National Audit Office review of treatment
(including SBI) - Social marketing campaign to reduce regular
excessive drinking - Inclusion of SBI in Quality and Outcomes
Framework (QoF)?
3COCHRANE REVIEW
- Effectiveness of brief alcohol interventions in
primary care populations - Eileen Kaner et al.
- http//www.mrw.interscience.wiley.com/cochrane/cls
ysrev/articles/CD004148/frame.html
4Has SBI been evaluated in ideal-world scenarios?
- Over recent years, there has been a growing view
that most of the BI trials have been tightly
controlled efficacy studies and not particularly
representative of routine clinical practice
5Is the evidence relevant to real world practice?
- Babor et al. 2006 There has been little
systematic research to evaluate the effectiveness
and cost of SBI under conditions approaching
typical clinical conditions
6Thus we decided to conduct a Cochrane
Collaboration review
7Aim
- To assess the effectiveness of brief
intervention, delivered in primary care (general
practice or accident emergency settings), at
reducing excessive alcohol consumption
8Efficacy-Effectiveness
- Efficacy studies
- Tightly controlled protocols
- Ideal world atypical practice
- High internal validity limited applicability
- Effectiveness studies
- Pragmatic trial reflect the noise in practice
- Closer to the real world routine practice
- High external validity broader applicability
9Conclusions
- In risky drinkers, BI reduces average weekly
drinking by 41g (about 4-5 units per week)
compared to controls - As little as 5 minutes of structured advice
enough - No significant benefit of longer BI or EI
- BI is highly effective in men, we need more
evidence in women - There is no significant difference in outcomes
between efficacy and effectiveness trials - Most of the evidence is skewed to the
effectiveness domain - BI evidence is highly relevant to routine PHC
10Screening and Interventions programme for
Sensible drinking (SIPS)
- Aka The Trailblazer project
- Alcohol Harm Reduction Strategy for England
(2004) The DH will set up a number of pilot
schemes by Q1/2005 to test how best to use a
variety of models of targeted screening and brief
intervention in primary and secondary healthcare
settings, focusing particularly on value for
money and mainstreaming (p.37) - National research consortium with expertise in
screening and brief interventions in the alcohol
field - Three different settings and three different
regions of England as different tools may be
necessary in different settings - Funded by DH 3.2 million,
-
11Research Project Group
- IOP
- Prof C Drummond (CI)
- Dr P Deluca
- Ms K Perryman
- St Georges
- Dr J Myles
- Dr A Oyefeso
- Mr T Phillips
- York
- Prof M Bland
- Mr S Coulton
- Prof C Godfrey
- Mr S Parrott
- Newcastle
- Prof E Kaner (DCI)
- Prof C Day
- Dr E Gilvarry
- Dr P Cassidy
- Dr D Newbury-Birch
- Prof Nick Heather
- Imperial College and St Marys Hospital
- Dr M Crawford
- Prof R Touquet
- Alcohol Concern
- Mr D Shenker
12Aims
- To identify the most appropriate, acceptable and
cost-effective - screening methods for AUD
- brief intervention techniques for AUD
- methods of implementation
- Across 3 health and social care settings
- Primary Health Care (PHC)
- Accident Emergency Departments (AED)
- Criminal Justice Services (CJS)
13Research Programme Design
- Three cluster randomised clinical trials (PHC,
AED, CJS) - Each with a purpose-designed project to assess
- Identification of the most effective screening
approach (universal vs targeted and 2/3 screening
tools) - Identification of the most effective and
cost-effective intervention approach - Barriers and facilitators to implementation
- 6 month follow-up
14Research Programme Design (cont.)
- To recruit patients from 24 PHC practices
- 9 AEDs
- 24 CJS
- Across North East, London, and South East Regions
- Aim to recruit over 2,600 patients across the
three trials - All health and CJS staff to receive training and
support from research team - Staff attitudes to be assessed to identify
acceptability of implementing screening and brief
interventions - Programme duration 2 years
15How will we assess implementation?
- Number screened, positives, received intervention
- Factors supporting implementation
- Factors impeding implementation
- Impact individual, service, costs and benefits
- Acceptability patient, practitioner,
commissioner - Sustainability
16How will we assess effectiveness?
- Effectiveness of implementation
- Extent of screening and intervention activity
- Attitudes to SBI implementation
- Patient outcome measures
- Alcohol consumption
- Alcohol-related problems
- Health-related quality of life
- Health-related and wider societal costs
17 Toolkit
- Screening toolkit and practical guidance for each
setting based on optimal tool/method
(targeted/universal)/setting combination - Intervention tools and implementation guidance
based on findings tailored to each setting - Training package for professionals in each
setting - Guide for commissioners of SBI services
- Resource website for providers
18Progress
- Recruited 9 AEDs 24 PHC practices
- Ethics and RD approval
- Completed CJS pilot
- Site training in Jan 08
- Pilot study report
- Feasibility, validity of screening tools, staff
attitudes - Interim report 2008
- Final report 2009
19PUBLICATIONS BY DEPARTMENT OF HEALTH
- Safe. Sensible. Social. (2007). Renewed National
Alcohol Strategy to assess progress since AHRSE
in 2004 - Strong on SBI (see pp. 36-39)
- Alcohol Misuse Interventions Guidance on
Developing a Local Programme of Improvement (Nov
2005) - Alcohol Needs Assessment Research project (ANARP)
covered SBI as well as specialist treatment
(Nov 2005) - Model of Care for Alcohol Misuse (June 2006)
- Review of Effectiveness of Treatment for Alcohol
Problems (Raistrick, Heather Godfrey Nov 2006)
20NATIONAL ROLL-OUT OF SBI
- Safe. Sensible. Social. The next steps in the
National Alcohol Strategy - states To support the roll-out and take-up of
targeted identification and brief advice, a
healthcare collaboration will be set up to
disseminate the early results of the trailblazer
research programmes and share learning on
implementation. - The DH will launch this support system by April
2008. An event has taken place in December 2007
to discuss the scale, scope and operation of this
supportive effort. - The DH brought together a range of PCT
Commissioners, PCT Public Health officials, GPs,
Practice Based Commissioners, Alcohol
Co-ordinators and specialist alcohol treatment
providers to discuss this effort. - NB. Public Service Agreement (PSA) on Reduction
of Alcohol-related Hospital Admissions
21NICE guidance on brief interventions
- National Institute for Health Clinical
Excellence is establishing a new Programme
Development Group (PDG) on The prevention and
Early identification of Alcohol Use Disorders in
Adults and Adolescents - To develop public health guidance in conjunction
with the Centre for Clinical Practice - Completion of project expected early 2010
22NATIONAL AUDIT OFFICE STUDYReducing
alcohol-related harm
- NAO is an independent body that reports to
Parliament on the economy, efficiency and
effectiveness with which government departments
have used their funding - Current study will include all types of health
service interventions on alcohol from brief
advice provided by GPs to rehabilitation and
detoxification services for dependent drinkers - It will examine the extent of local service
provision, access to services and the
effectiveness of treatment - Will report to Parliament in summer 2008
23SOCIAL MARKETING STRATEGY FOR HARMFUL DRINKERS
- DH has commissioned the COI Strategic Consultancy
to develop this strategy - Harmful drinkers refers to middle-aged (35)
regular excessive drinkers NOT young binge
drinkers - Hazardous drinkers will also probably be included
in the strategy - Likely elements of the strategy
- Attempt to reframe understandings of
alcohol-related harm - Provision of assisted self-help by a range of
media (mail, phone, web-based) - Encouragement of public to ask advice about
drinking from primary health care - Draft strategy to be ready May 2008
24QUALITY AND OUTCOMES FRAMEWORK
- Is inclusion of alcohol in QoF the key to routine
implementation of SBI? - DH full supportive of this development but it is
not their decision - Two attempts so far have been unsuccessful
- But remember Robert the Bruce!