Brief intervention reports highlight role of GPs but delivery still questionable

10 Aug

This post originally appeared on Alcohol Policy UK.

ABI reports SHAAPTwo new reports on alcohol brief interventions (ABIs) in Scotland have been released, highlighting the importance of GP settings and key factors influencing delivery.

The reports, published by Scottish Health Action on Alcohol Problems (SHAAP), are:

The delivery of ABI in Scotland, or ‘Identification and Brief Advice’ (IBA) as often known in England, has been a central component of national alcohol strategy across the UK, though debates over the quality and extent of implementation have been ongoing.The report on the practice and attitudes of General Practitioners is based on interviews across Scotland, which identified facilitators for the effective delivery of ABIs as falling into two key categories; systemic factors and patient-centred factors. These included key issues such as sufficient time, training and effective IT systems. Barriers were also identifiable in terms of structural and individual level issues, with the availability of cheap alcohol and normalisation of heavy drinking perceived as significant issues.

ABI report GP attitudes

The report on financial incentives reviewed available literature, examined a number of local systems and interviewed stakeholders. Available evidence indicated a limited and mixed picture, but with some indication of potential for incentives to encourage activity. Exploring local systems also presented a diverse picture and a lack of evidence to account for variations found. Stakeholders too presented contrasting views on the role of incentives, including in relation to the truth behind common concerns such as ‘gaming’ systems to generate income rather than ensuring quality intervention delivery. The report identifies a significant evidence gap remains despite the the ambition of Scotland’s ABI programme.

Professor Aisha Holloway, University of Edinburgh, said:

“Delivering Alcohol Brief Interventions (ABIs) is not just about the operational mechanisms associated with the national ABI programme i.e. funding, training and IT systems. It is also about GPs having the time to provide person-centred care to understand the complexities of external social and personal issues that people are facing that can trigger harmful/hazardous consumption.”

Dr Niamh Fitzgerald, Institute for Social Marketing, University of Stirling said:

“Whilst Scotland’s national programme of Alcohol Brief Interventions is amongst the most extensive of any country, it has contributed little in terms of research on how best to incentivise practitioners to talk to patients about alcohol. As Scotland rolls out its new national strategy, there is also an opportunity for Scotland to lead not only in terms of practice, but in developing globally innovative research on how to optimise such conversations to benefit patients.”

England and Wales – IBA CQUINs & ‘Have a Word’

Whilst attention of late has focused on Scotland’s battle for minimum unit pricing (MUP) – for which a final verdict is anticipated this year – the refresh of Scotland’s national alcohol strategy is likely to include further commitments to brief intervention delivery. SHAAP and the report’s authors will be hoping it includes attention to the issues and questions raised by the reports.

Meanwhile in England, no information has yet been released on the impact of the termination of the specific ‘DES’ incentive scheme in 2015 has had, if any. GP practices are still required to offer all new patients brief intervention under the general contract, though similarly key concerns have revolved around to what extent more than recording of screening results has been happening. Public Health England (PHE) have released a range of ‘Have a Word’ resources, originating from the Welsh national brief intervention programme.

Beyond Primary Care settings, efforts to incentivise IBA across hospitals and mental health trusts across the country should be underway as part of the NHS Commissioning for Quality and Innovation (CQUINs) payments framework from 2017-2019. The CQUIN separates alcohol IBA delivery into two equally weighted metrics – firstly screening using a validated tool, and secondly the delivery of alcohol ‘brief advice or referral’, with appropriate data collection for each.

In other settings, debates about whether brief intervention can be justified or have any significant effects have not stopped local implementation efforts. Various studies have also looked at a range of questions over IBA in non-healths settings, including the role of training.

PHE, NICE and other organisations have also encouraged local areas to seek IBA delivery across a range of settings. Last year an ‘IBA commissioning toolkit’ was released, encouraging systematic approaches and highlighting other case studies. Many in the field though will still agree with the authors of the SHAAP reports – important questions still remain over the ‘what, where, and how’ for effective IBA, as well as the very real challenges in implementing it.

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