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 Educational solutions for the NHS pharmacy workforce 1
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. Educational solutions for the NHS pharmacy workforce
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. Educational solutions for the NHS pharmacy workforce
Alcohol and Stafford Borough Educational solutions for the NHS pharmacy workforce 4
Public Health England Local Alcohol Profiles England Educational solutions for the NHS pharmacy workforce
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 Educational solutions for the NHS pharmacy workforce
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 Educational solutions for the NHS pharmacy workforce
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 offences. (36% of all recorded alcohol related violence was reported in Forebridge ward) Educational solutions for the NHS pharmacy workforce
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 Educational solutions for the NHS pharmacy workforce
Alcohol units – how much is too much? Educational solutions for the NHS pharmacy workforce
Units Male Female 3-4 Units a day 2-3 Units per day 21 Units per week 14 units per week 8 Units considered a binge 6 Units considered a binge With 1-2 alcohol free days With 1-2 alcohol free days per week per week Educational solutions for the NHS pharmacy workforce
Alcohol units – what do they look like? Educational solutions for the NHS pharmacy workforce
Quick alcohol unit calculator 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 Educational solutions for the NHS pharmacy workforce 13
Alcohol units Educational solutions for the NHS pharmacy workforce 14
Alcohol risks Risk Men Women Harmful effects Lower Risk No more than 3-4 units per No more than 2-3 units per There's no guaranteed safe level day on a regular basis day on a regular basis of drinking, but drinking less than the recommended daily limit lowers the risk of the harmful effects below. Increasing More than 3-4 units per day More than 2-3 units per day Progressively increasing risk of: Risk on a regular basis on a regular basis 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 More than 6 units per day on Increasing risks of those above on a regular basis or more a regular basis or more than than 50 units per week 35 units per week Educational solutions for the NHS pharmacy workforce 15
Pharmacy and Public Health: The Stafford Pharmacy Alcohol Advice Service Educational solutions for the NHS pharmacy workforce
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 Educational solutions for the NHS pharmacy workforce
Where does public health fit into the Pharmacy Contract? Essential services D ealing 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…….. Educational solutions for the NHS pharmacy workforce 18
Public health Brief advice and brief interventions Behaviour change Motivational interviewing Educational solutions for the NHS pharmacy workforce
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 Educational solutions for the NHS pharmacy workforce
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, or it might take up to three minutes. Educational solutions for the NHS pharmacy workforce
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 • Educational solutions for the NHS pharmacy workforce 22
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? Educational solutions for the NHS pharmacy workforce
Alcohol scratch cards Have a go with an alcohol scratch card • you will not be required to share your answer!!! Educational solutions for the NHS pharmacy workforce
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 or friend Educational solutions for the NHS pharmacy workforce
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 Educational solutions for the NHS pharmacy workforce
Opening phrases… 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? Educational solutions for the NHS pharmacy workforce 27
Consider What are the barriers to delivering an alcohol service? What do you need to consider? Educational solutions for the NHS pharmacy workforce 28
Consider Confidentiality Cultural sensitivity… First question should be: “Do Response – don’t push it you drink alcohol at all?” Don’t use labels, eg, Privacy – person’s right to ‘alcoholic’ refuse to engage Stigma attached to alcohol – Person’s right to say ‘no’ people may become to the service defensive ‘Making every contact Offer not just for today but count’ for the future if wanted Educational solutions for the NHS pharmacy workforce 29
Alcohol brief advice Educational solutions for the NHS pharmacy workforce
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