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Alcohol Aware Alcohol Aware PracticePractice
Rolande Anderson, Project Director, “Helping Patients with Alcohol Problems”,
Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2
Supported by Merck Pharmaceuticals.
A Joint ICGP/Department of Health Initiative
EU Study – Barcelona, 23-25 February, 2003
StatisticsStatistics
• 12.3 litres of pure alcohol per capita (2000)
• 2nd Beer consumption in world.
• Alcoholic drinks market worth €6.81 billion
• Approx. ¼ drinking above “safe” limits.
• Irish people – 47% + on alcoholic
drinks2000 v 1996– Why?
• ? ‘Celtic Tiger’• ? Availability• ? Marketting
• Mater Hospital study – In-patients Alcohol Abuse
or Dependence • 30% Male• 8% Female
• ESPAD Study – Ireland top of the league
for binge drinking among females
Alcohol Aware Practice Pilot Alcohol Aware Practice Pilot StudyStudy
Aims
To develop, at a General Practice level, programmes of concerted action involving all practice staff, in order to prevent, detect and treat patient problems associated with alcohol.
Screening Methods
• Urine Tests
• Blood Tests
• Breathalyser
• Clinical
Examination
• Asking
• Questionnaires – CAGE– Brief Mast– AUDIT– AUDIT C– Five Shot
We do this by……We do this by……
• Increasing staff awareness and expertise.
• Improving individual patient records of alcohol consumption.
• Developing an education / information plan.
• Training doctors to intervene effectively during every consultation.
• Training Practice Nurses.
• Maintaining intervention records.
We do this by……We do this by……
• Establishing practice policy on referral for more intensive care.
• Developing practice advocacy for such services where they are currently inadequate
• Appropriate use of screening instruments.
• Categorising all patients as ‘Non-Drinkers’, ‘Low risk’, ‘Hazardous’, ‘Harmful’ and ‘Dependent’ drinkers.
• Developing management guidelines appropriate to each category.
MethodsMethods
• Questionnaire– A.U.D.I.T.
• 1:5 patients• 1:9
– CAGE
RANDOMRANDOM
• Blood Tests– LFT’s– MCV
• Allocation of Patients– Low risk– Hazardous drinking– Harmful – Dependent
• Brief Intervention• Exclusion criteria• Training – key
practice staff• Follow-up • Referral• Materials
Health Board Areas of Ireland
The Area Covered by the ERHA
AAP Pilot Study Participating Practices
Treatment Overview—Alcohol
DUAL DIAGNOSIS NB. Depression & Other drugs
REFER
FOLLOW-UP INTERVIEW(S)
Outcome
RECORD
?DETOX Home Hospital
BRIEF INTERVENTION
Advise - cut down - abstain Motivation to change Discussion(s) Leaflets/Literature
ASK Clinical Interview Questionnaire(s) Blood Tests Patient History
ASSESS Physical Condition Psychological Condition Interview with Family Member Results
NON-DRINKER LOW RISK
NO PROBLEM
HAZARDOUS HARMFUL/DEPENDENCE
ResultsResults
• The results will look at the training programme and the three main areas of the study – screening, detection, treatment and referral.
• Weekly consumption of standard drinks will be recorded at the initial interview and again at a 3 month follow-up interview.
• Numbers screened and the percentage of those screened who fit into the ‘diagnostic categories’ ie. low risk, hazardous etc
• Figures will be broken down for each region with age and sex profiles.
• Action taken in terms of treatment and referral will also form part of the results.
• The practice staff will also be asked to evaluate the training programme, materials and pilot study.
AAP
Recording
Form
EvaluationEvaluation
• Comfort levels before and after on SCALES of 0-10:– Dealing with alcohol problems– Knowledge of withdrawal– Awareness of referral services– Knowledge of “safe”/weekly consumption levels– Ability to use questionnaires – Knowledge of brief intervention – Confidence in Dealing with Alcohol Problems
• Other Comments
Most Significant Advances
• ICGP Project “Helping Patients with Alcohol Problems” March 2000-February 2003.
• National Conference – “Alcohol and Young People”, October 2001.
• Alcohol Aware Practice Pilot Study (six months) commenced 4 September 2002
Barriers
• Funding
• GP Attitudes
• GP Confidence
Key Advances 2003-2004
• Expanded AAP Study
• Central Government Funding
• Training for GPs and Practice Nurses
• More committed personnel
• Special Type Consultation Fees
To make changes possible
• Belief that it is worthwhile amongst GPs
• Shifts in attitudes– GPs – Governmental– Health Boards
• Funding increases
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