Is self-completing the AUDIT OK for IBA?

22 May

Potential IBA’ers often ask if they can hand out the AUDIT or other screening tool for people to self-complete. Although better than not doing so, generally its a wasted opportunity if the person is able to go through it with them.

The main issue is what happens after a person has self-completed a screening tool rather than worked through it with a practioner. Where a practitioner has gone through the AUDIT with the drinker, this should flow nicely into ‘feedback’ and ‘brief advice’. The practitioner will probably have gotten a feel for the person’s alcohol use and a sense of whether they might be starting to contemplate their alcohol use.

Going through the AUDIT may be a crucial chance to build rapport with the drinker, and perhaps reassure them that you are adopting a non-judgemental and empathic approach. Other benefits, such as being able to check or clarify units knowledge are also missed by self-completion approaches.

In contrast, handing back a completed AUDIT seems to me a bit like handing in some homework and waiting for the teacher’s verdict. Not exactly in line with motivational principles. Worse still, I know some GP practices have been handing out screening tools for new registrations to self complete, but fail to follow it up with drinkers. This is unacceptable, especially given they are receiving a payment as part of the DES.

One of the key things some of the evidence seems to show is that screening itself appears to be a significant trigger for ‘contemplation’ that leads to change. Feedback and brief advice can capitalise on that process, helping the drinker to weigh up the pros and cons and perhaps identify a plan. Self-completing AUDIT  seems to mean that opportunity may be missed.

Nonetheless, self-completing an AUDIT is still likely to be beneficial when accompanied by feedback and an information leaflet. It’s also the foundation of online brief intervention approaches which are gaining recognition as having a valuable role to play in the overall IBA agenda. So in conclusion, someone self-completing an AUDIT + feedback can be valuable, but talking through it and being ready to guide someone (i.e brief advice) would be an opporutunity that I wouldn’t want to miss.

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3 Responses to “Is self-completing the AUDIT OK for IBA?”

  1. Laura Pechey May 24, 2012 at 12:22 pm #

    Where capacity or professional lack of interest means that self-completion is the only option, then the least we can do is try to make sure that a simple unit guide is included with a representative range of drinks to help people perform those tricky calculations. As you say James, online alcohol screening tools can help with unit calculation and should always be backed up by advice and pathways into support, like http://www.dontbottleitup.org.uk

  2. Simone July 18, 2012 at 9:56 am #

    I agree wholeheartedly. The issue is that in primary care, many GPs often take the easiest route which will earn them money, not necessarily the most effective one or the best one for their patients. In my experience, many struggle with the concept of client-centred care. I try to impress on practitioners that what is easier for them is not necessarily giving the patient choice and less likely to result in real engagement. This is made more difficult by health professionals who feel they have learnt their trade and are not interested in improving their consultation skills – a real barrier to progression and quite worrying considering how much influence and status they have. Squeezing in AUDIT C too as part of health checks or new patient registrations, and then not following that up, is another similar issue. Much of this is about a change in the way practitioners view their role and their responsibilities around supporting health.

  3. James Morris July 19, 2012 at 5:56 pm #

    I agree, there is a lot of resistance to recongising the benefits of Primary Care taking a procatice approach to prevention. But I do accecpt it can’t happen at every consultation. However if someone say presents with sy depression/anxiety and a GP doesn’t ask about alcohol use, that’s unacceptbale in my view!

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