Archive | July, 2014

#UKalcohol – Twitter discussion on IBA/brief interventions

30 Jul

A planned Twitter discussion on addressing alcohol harms will take place on Wednesday the 13th August at 8pm (= 20.00 BST = 19.00 GMT = 3pm/15.00 EDT) on the theme of alcohol brief advice and brief interventions.  This follows on from an initial discussion on alcohol-related hospital admissions which you can read here.

Who can take part?

The aim of the #UKalcohol discussions is to identify and discuss key issues facing those working in the alcohol field – either as commissioners, researchers, service providers or policy roles. It is hoped a different ‘theme’ will be addressed each month, reflecting key areas of interest.

#UKalcohol discussion 13th August: alcohol brief advice, brief interventions

The 2nd planned discussion is intended to cover the broad theme of design, delivery, support and monitoring of alcohol brief advice in addressing alcohol-related risks and harm.

The following issues may be used as needed as prompts/themes for discussion:

  1. What is brief advice, what is a brief intervention, does it matter?
  2. How widely should we implement brief advice/interventions on the basis of current evidence?
  3. What is needed to support brief advice/interventions in practice? How do the needs of different settings differ?
  4. How should brief advice/interventions on alcohol fit with attempts to address other lifestyle issues?
  5. What monitoring and evaluation of these interventions is needed and is it feasible?

Partnership

This 2nd discussion is being brought to you by the UK Centre for Tobacco and Alcohol Studies with the support from a range of partners and stakeholders who will be jointly supporting the alcohol Twitter discussion, and may initiate further themed discussions in future.

Next steps

If you are interested in participating in the proposed Twitter discussion either as an individual or on behalf of your organisation simply sign in via Twitter on Wednesday the 13th August at 8pm and use the #UKalcohol. Discussion may be subsequently captured and shared via Storify.  You can also follow @ukctas to see tweets about this in advance.

If you’d like to ask any questions or help with Twitter please do get in touch via niamh.fitzgerald@stir.ac.uk or james@alcoholacademy.net.

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IBA Primary Care case study: a rare new example

29 Jul

preventionIn 2011 a ground-breaking document (in the IBA world at least) was released by a brilliant local service in Haringey. The document was a step-by-step guide to implementing the DES incentive scheme for IBA for new registrations in Primary Care. However what was arguably most impressive was the work revealing the local ‘DES picture’, which was not pretty reading.

The review found, to give just a few examples, that 75% of practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice to identified risky drinkers. However such issues are likely to be commonplace if anecdotal reports and mystery shopping are anything to go by. The Haringey work though subsequently enabled action to significantly improve local IBA delivery.

So it seems apparent that the DES scheme itself does not result in good quality IBA – much more is needed to make that happen. Not a surprise really, but part of the problem has been a lack of available reports to identify this.  Any new pieces of work evidencing local IBA experiences and action in relation to the DES are therefore to be welcomed.

A new case study – Cruddas Park Practice

I recently came across a valuable piece of work in the North East – a report from a pilot [pdf] which aimed to assess the practicality of implementing IBA into a busy GP practice. Again, this seemed to be the result of prior some work looking at the local picture. A survey of GPs carried out by Balance found that GPs were typically only addressing alcohol in response to clinical indicators, rather than routinely as IBA is intended. Time pressures and competing priorities were the recurring reasons offered for this.

The report provides a valuable insight into a local effort to properly implement IBA and supporting pathways into a busy GP practice. It looks at the compelling local need, and evidence base, but most of all, it gives a real insight into how perceptions and practice in relation to IBA can be changed by a relatively simple project.

Some of the best insights from the report related to the feedback from the staff who delivered IBA. It is always heartening to hear a busy practitioner relay a real life positive attitude to IBA, like this example:

“One guy had a health check and his cholesterol was up, he was drinking most days, now he has cut out drinking through the week. I told him his attitude was great. He had never thought about it until he came to the GP, he is sleeping better, he feels better. He thanked me and it made me feel good.”

Of course the reality is its not straightforward. This quote really captures probably the biggest overall challenge to IBA:

“Sometimes the timing is an issue, for people who screen mid way it’s not too bad, but if people score high you need to spend more time with them. It takes a double appointment – about 20 minutes. Or I add it into an annual check it takes an extra five minutes. It’s hard to judge how long it will take until you ask the questions. You definitely need longer – especially if they need to discuss the issues more, you don’t want to hurry people if they are listening.”

There is one issue I feel I should point out with the report itself. It suggested higher risk drinkers (16-19 AUDIT scores) were offered referral for advice or extended brief interventions as the main output, rather than offering ‘brief advice’ as a starting point and only then offering referral if needed or sought. The evidence doesn’t suggest EBI is superior to IBA for higher risk drinkers in most cases – see Clarifying Brief Interventions for more.

However the report is still a highly valuable and rare example of the type of attention that’s needed to convert patchy or inadequate IBA to a standard that really makes a difference. Good, simple IBA isn’t that hard after all.. is it?

Alcohol IBA ‘training app’ released

1 Jul

IBA An IBA training app was recently released on the apple store, Google play and also on the amazon app store. The free app is available to download to support front line health or social care professional roles to offer simple alcohol brief intervention.

The app contains a simple format to introducing the key fundamental knowledge and skills required to offer alcohol ‘Identification and Brief Advice’, with a focus on possible scenarios and responses. Firstly, the app offers a background to IBA and how early intervention for alcohol misuse is suitable for around a quarter of the adult population. It also offers interactive sections exploring key areas such as alcohol units and the AUDIT screening tool.

risk groupsThe main focus of the app focuses on a number of scenarios demonstrating suggested ‘brief advice’ responses as well as examples of how not to respond to ambivalent or resistant responses. The scenarios include actors playing increasing, higher risk and possibly dependent drinkers, each showing a range of possible attitudes and practitioner responses.

The app offers a shorter alternative to the 2 hour online IBA e-learning which has proven a popular resource. Nonetheless, good face to face training should still be considered the gold standard training approach. Of course many busy front line roles may not have access to face to face training so the app offers a quick and effective introduction to IBA delivery.