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)
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? 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 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 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
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
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
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