What do we already know about screening and brief interventions?

What do we already know about screening and brief interventions?

• What do we already know about screening and brief interventions?

• What research questions will SIPS address?

• What is SIPS and how did it come about?

• What will come out of SIPS over the next year?

Acute effects

• Acute effects

• Highly variable
• Pleasure, relaxation
• Impaired judgement, coordination, balance
• Mood effects
• Argumentativeness and aggression
• Drowsiness
• Impaired consciousness
• Coma, respiratory depression and death.

26% of the adult population have an alcohol use disorder (AUD)

• 26% of the adult population have an alcohol use disorder (AUD)

• Includes 38% of men & 16% of women aged 16-64

• 23% of the adult population are hazardous or harmful alcohol users (7.1 million people in England)

• 21% of men and 9% of women engage in binge drinking

• Prevalence of alcohol dependence is 3.6% overall, 6% among men, and 2% among women (1.1 million people in England)

Funded by Strategy Unit/Dept of Health

• Funded by Strategy Unit/Dept of Health

• Maximum burden of alcohol on A&E departments

• Regional variations

• 36 randomly selected A&Es in England (18%) stratified by region and urban/rural

• 116 researchers, 25 regional coordinators

• All A&E attenders > 18 years between 0900 and 0859hr Saturday/Sunday

Predictors of ETOH+

• Predictors of ETOH+

• Young, white, males, single/divorced, unemployed, living with parents or NFA, frequent attenders (1.6x)
• More often brought by police/ambulance

• Reasons for attendance

• Violent assaults involving weapons, RTA, psychiatric emergency, DSH
• Weapons: fists, knives, shoes, glasses
• Locations: clubs, pubs, public transport

• Correlations with general population data

• Fridays and Saturdays: Estimated 1,000,000 alcohol related A&E attendances per annum

Pragmatic RCT comparing leaflet with referral to Alcohol Health Worker

• Pragmatic RCT comparing leaflet with referral to Alcohol Health Worker

• Screening using Paddington Alcohol Test

• 599 randomised

• AHW group less drinking than leaflet

• Fewer AED attendances (mean 0.5)

• AHW more cost effective

Prevalence ~20-30%

• Prevalence ~20-30%

• Frequent attenders

• Screening & health promotion role

• Early detection & intervention

• Effect of alcohol intervention on health outcomes

• 5-30 min of targeted advice

Freemantle 1993 - 6 trials in primary care

• Freemantle 1993 - 6 trials in primary care

• 24% drop in consumption (95% CI 18 to 31%)

• Moyer 2002 – 56 trials, 34 relevant to PHC

• Consistent positive effect, NNT 8-12 (smoking=20)
• Cost savings found at 4 years in the USA

• Kaner 2007 – 29 trials in PHC & A&E

• Consistent positive effects ~7 drinks less/week
• Evidence strongest for men, less work on women
• No significant benefit of longer versus shorter BI

A&E: SBI is effective and cost effective in academic centres (e.g. St Mary’s Model)

• A&E: SBI is effective and cost effective in academic centres (e.g. St Mary’s Model)

• Primary Health Care: SBI is effective and some evidence of cost effectiveness across range of international settings

• General Hospital: SBI less effective

• General lack of research in UK

• In all cases SBI effective for opportunistic intervention in non-treatment seeking populations. Less effective for treatment seeking/alcohol dependent patients

A&E: can it be effectively implemented outside academic centres in UK?

• A&E: can it be effectively implemented outside academic centres in UK?

• PHC: is it cost effective and can it be implemented in “typical” PHC setting?

• CJS: is it feasible to implement SBI, and is it effective?

• All settings:

• What are the best screening tools (short vs longer) and method (universal vs targeted)?
• Is extended BI better than 5 min advice?
• What are the barriers/facilitators for implementation in the “typical” setting?
• Effectiveness in females, young, BME

Funded by Department of Health for 3 years

• Funded by Department of Health for 3 years

• Jointly led by IOP & Newcastle University

• 3 cluster randomised clinical trials of alcohol screening and brief intervention (PHC, AED, CJS) to assess:

• What are the barriers/facilitators to implementation in a “typical setting”?
• What is the most effective screening method?
• What is the most effective and cost effective intervention approach?

• Total target of 2,403 subjects, completed 2,600 July 2009

• 6 and 12 months follow up, currently 80% @ 6 months (mainly phone)

King’s College London

• King’s College London

• Prof C Drummond (CI)

• Dr J Myles PI

• Dr P Deluca PI

• Mr T Phillips PI

• Ms K Perryman PI

• Dr M Cochrane

• Ms D Jeffery

• Dr M Hobbs

• Ms R Cappello

• Mr S Keating

• Ms L James

• Ms L Rail

• Ms J Reid

• Ms R Lee

• Mr S Gordon

• Ms L Floodgate

• Mr D Kerr

• Mr H Mosaheb

• Ms C Elzerbi

• St George’s

• Dr A Oyefeso PI

• York

• Prof S Coulton PI (now Kent Univ)

• Prof C Godfrey PI

• Mr S Parrott PI

• Prof M Bland PI

Effectiveness of implementation

• Effectiveness of implementation

• Extent of screening and intervention activity
• Attitudes to SBI implementation

• Patient outcome measures

• Alcohol consumption (extended AUDIT-C)
• Alcohol related problems
• Health related quality of life
• Health related and wider societal costs

www.sips.kcl.ac.uk

• www.sips.kcl.ac.uk

Accident and Emergency study: Dr Paolo Deluca

• Accident and Emergency study: Dr Paolo Deluca

• Primary care study: Prof Eileen Kaner

• Criminal justice study: Dr Dorothy Newbury-Birch

• Early findings on screening: Prof Simon Coulton

• Discussant: Dr Peter Anderson