Archive | October, 2017

‘Health Matters’: PHE resources on brief intervention CQUIN

23 Oct

This post originally appeared on Alcohol Policy UK.

Public Health England (PHE) have released a new ‘Health Matters: preventing ill health from alcohol and tobacco use’ resource calling on practitioners and commissioners to ‘play their part’ in reducing alcohol harms through Identification and Brief Advice. A case study of an IBA CQUIN in mental health settings in South London also provides insight into local implementation efforts.

In 2016 it was announced mental health and hospital trusts in England would be incentivised to deliver brief interventions for alcohol and smoking as part of the NHS Commissioning for Quality and Innovation (CQUINs). PHE says CQUIN No.9 Preventing Ill Health by Risky Behaviours is ‘an important opportunity to improve patient health across England’ via the opportunity to ‘identify and support inpatients who are increasing or higher risk drinkers and to identify and support inpatients who smoke, and importantly to embed these interventions into routine care for patients.’

PHE have included a set of infographics which demonstrate the case for implementing alcohol IBA including a potential Return on Investment (ROI) of £27 per patient over four years. PHE say if ‘implemented well the CQUIN has the potential to reduce future hospital admissions and reduce the risk of a number of chronic conditions such as heart disease and, stroke and cancer’, but ‘for it to be effective we need all health professionals, commissioners and local authorities to play their part.’

Many local areas will have already been seeking to implement IBA across a range of settings, either via previous locally commissioned CQUINs or other service provider agreements, or perhaps optimistically by simply training staff roles or dissminating ‘scratch-cards’. Other areas may have focused on the embedding digital interventions, IBA across other settings or novel approaches such as IBA direct.

PHE

Efficacy Vs Effectiveness?

IBA has been a central component of alcohol prevention strategies in the UK and in other countries, but whilst there may be good evidence from research trials, the extent of effective routine implementation remains questionable. As such, debates over whether the benefits of brief interventions seen in research trials can be translated to busy front-line settings continue. Indeed such questions may be complicated by the difficulties in researching complex behavioural effects across different settings and population groups, and studies that have had more mixed implications such as SIPS.

Certainly then PHE’s recognition of the need to see such a scheme as ‘well implemented’ in order to see the desired effects seems well warranted. Questions over the actual delivery of ‘brief advice’ conversations beyond simply numbers of people screened or given a leaflet are not possible to answer. Indications from patient studies suggest very few risky drinkers recieve brief advice from their GP practices compared to smokers, despite a national requirement for practices to deliver IBA to new registrations or via health checks. As such calls have been made to do more to consider measures of implementation beyond reported numbers including a ‘national centre’ of IBA, similar to the NCSCT which exists for smoking.

Meanwhile PHE and others have continued to produce resources and toolkits for implementing alcohol strategies which may be seen as important in sustaining local efforts to deliver preventative alcohol interventions, whilst some areas have focussed on ‘Making Every Contact Count’ (MECC) approaches. For others the crucial question may be how achievable ambitions to deliver non-urgent preventive interventions are if pressures on front line services continue to mount.

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