Alcohol identification and brief advice New Service Workshop Gill - - PowerPoint PPT Presentation

Educational solutions for the NHS pharmacy workforce

Alcohol identification and brief advice

New Service Workshop Gill Hall

Educational solutions for the NHS pharmacy workforce

Educational solutions for the NHS pharmacy workforce

Alcohol – Some Stats

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Educational solutions for the NHS pharmacy workforce

Alcohol…sobering stats?

 85% of adults drink alcohol  21% of adults in England (9 million) drink more than gvt lower risk guidelines  About 2 million adults drink at higher risk levels

• 1.3 million men drink 50+ units per week
• 700,000 women drink more than 35 units per week

 Alcohol responsible for 8% of hospital admissions

• 511,000 in 2002/03 to 1.2 million in 2009/10

Data from DH Health Improvements Analytics Feb 2010.

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Alcohol…sobering stats?

 Alcohol misuse contributes to 48 conditions

• 13 conditions were wholly attributable to alcohol consumption
• 35 conditions were partially attributable to alcohol

consumption  Areas of higher deprivation (vs more affluent areas)

• 2-3 times higher loss of life
• 2-5 times more admissions to hospital

Data from DH Health Improvements Analytics Feb 2010.

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Alcohol and Stafford Borough

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Public Health England

Local Alcohol Profiles England

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Stafford Borough District Profile April 2013

 Locally hospital admissions as a result of increased alcohol consumption have increased considerably.  Admissions wholly related to alcohol (e.g. alcoholic liver disease and overdose) now 323 per 100,000 males and 211 per 100,00 females  Alcohol-attributable admissions (includes conditions caused by alcohol e.g. unintentional injury, stomach cancer) increased from 1237 per 100,000 in 2006/7 to 1709 per 100,000 in 2010/11

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Stafford Borough District Profile April 2013

Hospital admissions for under 18’s  Higher for females than males  Rate among highest in county  Higher than estimates for West Mids as a whole  Stafford health profile 2012 showed Stafford has 107 per 100,000 population alcohol related hospital stays

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Stafford Borough District Profile April 2013

 24% of people drinking in Stafford at higher risk levels (adults and over 16s). This is higher than national average for England (but not sig higher)  470 alcohol related offences in 2011/12 in Stafford Borough (equates to 27% of all violence in Stafford Borough). Believed to be under-recorded!  Where alcohol is recorded, mainly a factor in Town Centre

• ffences. (36% of all recorded alcohol related violence was

reported in Forebridge ward)

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Stafford Borough District Profile April 2013

 Stafford Borough Population is around 130,800 (2011 census). 105,300 adults  If 85% of adults drink alcohol – 89,500 adult drinkers  If 24% drinkers drink at higher risk levels – 21,500 high risk drinkers

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Alcohol units – how much is too much?

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Units

Male

 3-4 Units a day  21 Units per week  8 Units considered a binge With 1-2 alcohol free days per week

Female

 2-3 Units per day  14 units per week  6 Units considered a binge With 1-2 alcohol free days per week

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Alcohol units – what do they look like?

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Alcohol by Volume (ABV%) x Volume (mL) = No. of units 1000 Examples Pint of Beer/Lager/Cider - 5% 5 x 568mL ÷ 1000 = 2.84 units Bottle (750mL) Wine - 12% 12 x 750mL ÷ 1000 = 9 units

Quick alcohol unit calculator

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Alcohol units

Educational solutions for the NHS pharmacy workforce

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Alcohol risks

Risk Men Women Harmful effects Lower Risk No more than 3-4 units per day on a regular basis No more than 2-3 units per day on a regular basis There's no guaranteed safe level

• f drinking, but drinking less

than the recommended daily limit lowers the risk of the harmful effects below. Increasing Risk More than 3-4 units per day

• n a regular basis

More than 2-3 units per day

• n a regular basis

Progressively increasing risk of:  Accidental injury  Alcohol dependence  Anxiety  Cancer  Depression  Heart disease  Hypertension  Impotence  Infertility  Insomnia  Lethargy  Liver disease  Memory loss and dementia  Pancreatitis  Relationship problems Higher Risk More than 8 units per day

• n a regular basis or more

than 50 units per week More than 6 units per day on a regular basis or more than 35 units per week Increasing risks of those above

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Pharmacy and Public Health: The Stafford Pharmacy Alcohol Advice Service

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Alcohol scratch cards and Information Leaflets for every pharmacy in Stafford Borough signing up to the service – essential services. Activity Full AUDIT & Brief Intervention @ £5 Follow-up interventions @ 4&8 weeks @ £5 Recording and administration will be on PharmOutcomes

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Where does public health fit into the Pharmacy Contract?

 Essential services

Dealing with common ailments; healthy lifestyle advice for those

presenting prescriptions for diabetes, CHD or hypertension, who appear to be overweight or who smoke; signposting

 Advanced services

Medicine Use Review (MUR) and New Medicine Service (NMS)

 Locally Commissioned Services

Substance misuse, EHC, stop smoking, alcohol IBA, weight management etc……..

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Public health

Brief advice and brief interventions Behaviour change Motivational interviewing

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Very brief advice

 Takes 30 seconds  Ask - establish and record (eg smoking status, alcohol intake)  Advise - that the best way to change the behaviour is with support and treatment  Act - offer help

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Brief advice

 Brief advice in a pharmacy setting is taking the opportunity to raise and assess a person’s willingness to engage in further discussion about a healthy lifestyle issue.  This may only take a few moments , certainly where the individual expresses an unwillingness to discuss the issue,

• r it might take up to three minutes.

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Remember - Brief Advice is…

• pro-active and opportunistic
• assessing a person’s willingness to engage
• takes a few moments - up to 3 minutes
• a contractual requirement
• part of the Healthy Living Pharmacy ethos

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Step 1: Alcohol scratch cards

 Before you ask the client to complete a scratch card -  What should your first Question be?

• Do you drink alcohol at all?

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Alcohol scratch cards

 Have a go with an alcohol scratch card

• you will not be required to share

your answer!!!

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Alcohol scratch cards

 Why are we using cards?

• Easy/non threatening way to

engage people?

• Filters out those at low risk?
• Could take one for a family member
• r friend

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Alcohol scratch cards

 Portsmouth HLPs

• June 2010 campaign
• 3500 people used scratch cards
• 1784 brief advice and leaflet
• 830 brief intervention

consultation

• 29 referred to specialist alcohol

services

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Start with:  “Do you drink alcohol at all...?” If the answer is ‘yes’, possible next phrases are:  “We are offering a new service…”  “Looking at what medication you are on you may wish to consider the effects of alcohol…”  “We are interested in finding out more about....” This project gives us a new option  WOULD YOU BE INTERESTED IN HAVING A GO AT THIS NEW ALCOHOL SCRATCHCARD WE’RE USING?

Opening phrases…

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Consider

 What are the barriers to delivering an alcohol service?  What do you need to consider?

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Consider

 Confidentiality  Response – don’t push it  Don’t use labels, eg, ‘alcoholic’  Stigma attached to alcohol – people may become defensive  Offer not just for today but for the future if wanted  Cultural sensitivity… First question should be: “Do you drink alcohol at all?”  Privacy – person’s right to refuse to engage  Person’s right to say ‘no’ to the service  ‘Making every contact count’

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Alcohol brief advice

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 Brief advice is a short intervention delivered

• pportunistically. It can be used to raise awareness of, and

assess willingness to engage in further discussion about, healthy lifestyle issues such as harmful drinking patterns and the associated effects.  It is less in-depth and more informal than a brief intervention and usually involves giving information about behaviour change and simple advice, such as how to reduce alcohol consumption to sensible levels.

What is brief advice?

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 The recommended brief intervention is five minutes of brief advice developed by the World Health Organization.  See: http://www.alcohollearningcentre.org.uk/_library/Resources/AL C/Brief_Advice_Training.ppt  Content:

• Understanding units
• Understanding risk levels
• Knowing where they sit on the risk scale
• Benefits of cutting down
• Tips for cutting down

What is brief advice?

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 Empathetic  Avoid labelling  Understand there are preconceptions: both healthcare professionals and the public  Supportive  Non-threatening / non-confrontational  Body language and speech tone

Principles of brief advice

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 Reduction from higher-risk to lower-risk drinking in 250,000 men and 67,500 women each year  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  Brief advice can reduce weekly drinking by between 13 percent and 34 percent  For every eight people who receive simple alcohol advice,

• ne will reduce their drinking to within lower-risk levels

 This compares favourably with smoking, where only one in 20 will act on the advice given

Benefits of brief advice

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Alcohol brief intervention (paid service)

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What is a Brief Intervention?

A brief intervention is undertaken where someone responds positively to opportunistic brief advice or specifically asks for help with a health related issue A brief intervention is targeted at supporting behavioural change and may involve offering a specialist service such as enrolment into a local smoking cessation clinic or obesity programme or in our case ALCOHOL service

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Pre- contemplation

• Gentle fact giving
• Encourage client to think

what life may be like without behaviour

Contemplation

More specific facts Focus on benefits Myth breaking Confidence building Assess readiness

Preparation

Confidence building Explain support available Discuss medication

• ptions

Discuss coping mechanisms and preparation

Action

Encouragement & confidence building Support for medication use Problem solving

Maintenance

Confidence building – success Discuss possible pitfalls Remind about facts

Stable in change

Leave the door open

Relapse/Lapse

Discuss causes Assess readiness Build confidence

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Ambivalence

 individuals “stuck” in their behaviour  behaviours are choices  life is dull not drinking, but drinking causes harm

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Cognitive Dissonance

 measures the difference between what a person does [the behaviour] and what the person knows [cognitive] they should be doing  the bigger this difference, change more likely  created in a number of ways

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Motivational interviewing

 Explores the ambivalence people feel about making a change, weighing the advantages of making the change against the disadvantages of giving up the behaviour  Client centred, client is an active participant not a passive recipient of expert knowledge  Discussion focuses on client’s experiences and feelings , their aspirations and motivations, not healthcare professional’s attempt to persuade the client to change

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Motivational interviewing principles

Five principles of motivational interviewing  Express empathy  Avoid argument and ‘roll with resistance’  Build self-confidence  Encourage to state their own reasons for change  Summarise

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Closing a brief intervention

Use closed questions…  Are you happy to go away and have a think about what we talked about?  Has our chat been useful for you?  Have you got some ideas on how to [change behaviour]?  Would you like to talk to someone about [behaviour]?  Signpost to local support services

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Record service provisions on PharmOutcomes

PharmOutcomes

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AUDIT-C score of 4 or less?

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AUDIT-C 4 or less?

Congratulate on their drinking within guidelines  Offer Information Leaflet  Ongoing support available  Do they have a friend of family member who may be interested in this information service?  Record data on recording sheet for addition to PharmOutcomes later.

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Moving from AUDIT-C score of 5+ to the next stage

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How will we engage people to take full AUDIT

Different approaches for different groups?  Young people?  Someone with a Long Term Condition?  Older person in denial?  EHC consultation – (already have to ask if alcohol involved)?  Parents – with a young family?  Someone worried about a friend or relative?

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What to do with Full AUDIT score

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Full AUDIT scores

Score less than 9  Offer Information Leaflet  Ongoing support available  Do they have a friend of family member who may be interested in this information service?  Record on Stage 1 and 2 PharmOutcomes

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Full AUDIT scores

Score 9 to 16  Brief Intervention  Information Leaflet  Ongoing support available  Invite to service – follow up at week 4 and 8  Record on PharmOutcomes Stage 1 and 2  Do they have a friend of family member who may be interested in this information service?

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Full AUDIT scores

Score 9 to 16 – Follow Up at 4 and 8 weeks  Complete AUDIT-C (to assess any behaviour change)  This can be by telephone  Record on PharmOutcomes Stage 3 and / or 4  Do they have a friend of family member who may be interested in this information service?

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Full AUDIT 16+

Refer  NEVER advise a dependant drinker to stop drinking – always REFER!  NEVER advise anyone to go cold turkey – always REFER!  Refer to One Recovery  Telephone, email or paper.

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Next Steps

 Role play practice – look at those on back of quiz sheet  Look at pre-workshop tasks – signposts to learning resources  Alcohol learning centre – open access learning  Pharmacists and Reg Techs can download (and complete) CPPE OL on alcohol  Pharmacy Resource Pack from LPC – available via PharmOutcomes  Start date: 17th November 2014