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Who and where for IBA – are nurses and universities best?

11 Oct

A recent systematic review of alcohol brief interventions looked specifically at whether the ‘setting, practitioner group and content matter?’. Based on data from 52 research trials, the results conclude that alcohol brief interventions ‘play a small but significant role in reducing alcohol consumption’ – but also identifies some differences based on where and by whom.nurse

Perhaps the most significant finding is that IBA delivered by nurses were found to be most effective. This may be seen as promising given the reach of nurses and recognition of the role of IBA in healthcare settings. However the study cannot tell us how much this finding may be as a result of the way in which nurses deliver the intervention versus other factors such as nurses being seen as a credible person to offer alcohol advice.

As such it suggests nurses should be seen as a priority for the delivery of IBA, with efforts needed to address key barriers of time, worry about losing trust of the patient and inadequate training. It also emphasises previous research suggesting ‘a good relationship between the practitioner and the client’ as an important factor.

The findings also suggest the less intensive approach of ‘brief advice’ was found more effective than longer motivational interviewing interventions. However concerns over ‘brief advice’ being interpreted as simply feedback and a leaflet -rather than say 5-10 minutes structured advice – should be noted.

Another key finding was that when comparing settings, universities were found to have the greatest effect size alongside primary care – surprising given the limited level of attention to IBA in universities. Perhaps another unexpected findings was a lack of evidence for IBA in A&E settings. Whilst previous studies have found small effects, the review suggests that the specific time pressures within A&Es, lack of privacy and seriousness of injuries may be significant in hampering its value as a setting.

The authors rightly highlight limitations to the research and caution over drawing firm conclusions about role and settings. However it may be fair to summarise that it strengthens the case for shorter ‘brief advice’ to be delivered by nurses in particular. In addition, further focus on the potential of universities as a setting for delivery may also be an important area for development. Meanwhile the possibly limited benefits of IBA delivery in busy A&E settings may need to be weighed up against the level of effort required.

See here for an analysis of the research on the Mental Elf blog.

SIPS: largest ever UK study into alcohol brief interventions

15 May

Orginally posted on Alcohol Policy UK:

SipsFindings from the SIPS trial, the largest UK alcohol screening and brief intervention study, have been released.

The study took place across key settings of Primary Care, Emergency Departments and Probation and tested the effectiveness of a range of brief intervention approaches and screening tools. A conference event took place on the 5th of March 2012 to launch the findings, with presentations available to download.

SIPS covered 9 Emergency Departments, 29 GP surgeries and 20 Probation Offices across London, the South East and the North East of England. During the 13-month data collection period 10,530 patients were screened with 2,481 recruited into the study. The trial tested three key ‘brief intervention’ approaches of:

  1. Feedback [of screening result] + Patient Information Leaflet (PIL)
  2. Feedback + five minutes of structured advice using the SIPS brief advice tool + PIL
  3. Feedback + 20 minutes of ‘Brief Lifestyle Counselling’ (BLC) + PIL

For Emergency Departments, the Modified Single Alcohol Screening Question (M-SASQ) was found to be the most efficient and effective screening tool. However successful implementation in EDs required champions and dedicated staff. In terms of results, all three approaches showed positive outcomes on drinking behaviours, with greater effects at 12 than 6 months. However when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. However lifestyle counselling was considered to have a greater cost impact due to greater QALY gains and a greater reduction in societal costs.

In Primary Care settings, the FAST alcohol screening tool was the most efficient and effective screening tool. Successful implementation though required financial incentives, training and ongoing specialist support, though longer lifestyle/extended interventions were harder to implement. All brief intervention approaches resulted in reductions in alcohol use, but when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. Feedback and leaflet was found to be the most cost-effective approach.

In Probation (Criminal Justice) settings, the FAST was also found to be the most effective screening tool. Successful implementation was challenging, requiring managerial support and ongoing specialist input to maintain activity. For ‘increasing risk’ [hazardous drinkers] who scored between 8-15 on the AUDIT, simple feedback and leaflet was as effective as longer interventions or lifestyle counselling. However for ‘higher risk’ [harmful] drinkers scoring 16 or more on the AUDIT, more intensive interventions were beneficial.

See the SIPS website for forthcoming further analysis and details of the SIPS ‘junior’ trial which will explore the impact of brief intervention approaches on young people.