Alcohol Aware Alcohol Aware PracticePractice

Rolande Anderson, Project Director, “Helping Patients with Alcohol Problems”,

Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2

Supported by Merck Pharmaceuticals.

A Joint ICGP/Department of Health Initiative

EU Study – Barcelona, 23-25 February, 2003

StatisticsStatistics

• 12.3 litres of pure alcohol per capita (2000)

• 2nd Beer consumption in world.

• Alcoholic drinks market worth €6.81 billion

• Approx. ¼ drinking above “safe” limits.

• Irish people – 47% + on alcoholic

drinks2000 v 1996– Why?

• ? ‘Celtic Tiger’• ? Availability• ? Marketting

• Mater Hospital study – In-patients Alcohol Abuse

or Dependence • 30% Male• 8% Female

• ESPAD Study – Ireland top of the league

for binge drinking among females

Alcohol Aware Practice Pilot Alcohol Aware Practice Pilot StudyStudy

Aims

To develop, at a General Practice level, programmes of concerted action involving all practice staff, in order to prevent, detect and treat patient problems associated with alcohol.

Screening Methods

• Urine Tests

• Blood Tests

• Breathalyser

• Clinical

Examination

• Asking

• Questionnaires – CAGE– Brief Mast– AUDIT– AUDIT C– Five Shot

We do this by……We do this by……

• Increasing staff awareness and expertise.

• Improving individual patient records of alcohol consumption.

• Developing an education / information plan.

• Training doctors to intervene effectively during every consultation.

• Training Practice Nurses.

• Maintaining intervention records.

We do this by……We do this by……

• Establishing practice policy on referral for more intensive care.

• Developing practice advocacy for such services where they are currently inadequate

• Appropriate use of screening instruments.

• Categorising all patients as ‘Non-Drinkers’, ‘Low risk’, ‘Hazardous’, ‘Harmful’ and ‘Dependent’ drinkers.

• Developing management guidelines appropriate to each category.

MethodsMethods

• Questionnaire– A.U.D.I.T.

• 1:5 patients• 1:9

– CAGE

RANDOMRANDOM

• Blood Tests– LFT’s– MCV

• Allocation of Patients– Low risk– Hazardous drinking– Harmful – Dependent

• Brief Intervention• Exclusion criteria• Training – key

practice staff• Follow-up • Referral• Materials

Health Board Areas of Ireland

The Area Covered by the ERHA

AAP Pilot Study Participating Practices

Treatment Overview—Alcohol

DUAL DIAGNOSIS NB. Depression & Other drugs

REFER

FOLLOW-UP INTERVIEW(S)

Outcome

RECORD

?DETOX Home Hospital

BRIEF INTERVENTION

Advise - cut down - abstain Motivation to change Discussion(s) Leaflets/Literature

ASK Clinical Interview Questionnaire(s) Blood Tests Patient History

ASSESS Physical Condition Psychological Condition Interview with Family Member Results

NON-DRINKER LOW RISK

NO PROBLEM

HAZARDOUS HARMFUL/DEPENDENCE

ResultsResults

• The results will look at the training programme and the three main areas of the study – screening, detection, treatment and referral.

• Weekly consumption of standard drinks will be recorded at the initial interview and again at a 3 month follow-up interview.

• Numbers screened and the percentage of those screened who fit into the ‘diagnostic categories’ ie. low risk, hazardous etc

• Figures will be broken down for each region with age and sex profiles.

• Action taken in terms of treatment and referral will also form part of the results.

• The practice staff will also be asked to evaluate the training programme, materials and pilot study.

AAP

Recording

Form

EvaluationEvaluation

• Comfort levels before and after on SCALES of 0-10:– Dealing with alcohol problems– Knowledge of withdrawal– Awareness of referral services– Knowledge of “safe”/weekly consumption levels– Ability to use questionnaires – Knowledge of brief intervention – Confidence in Dealing with Alcohol Problems

• Other Comments

Most Significant Advances

• ICGP Project “Helping Patients with Alcohol Problems” March 2000-February 2003.

• National Conference – “Alcohol and Young People”, October 2001.

• Alcohol Aware Practice Pilot Study (six months) commenced 4 September 2002

Barriers

• Funding

• GP Attitudes

• GP Confidence

Key Advances 2003-2004

• Expanded AAP Study

• Central Government Funding

• Training for GPs and Practice Nurses

• More committed personnel

• Special Type Consultation Fees

To make changes possible

• Belief that it is worthwhile amongst GPs

• Shifts in attitudes– GPs – Governmental– Health Boards

• Funding increases