A&E St. Mary’s 'Scientia Vincit

Timorem'

Alcohol Screening and Brief Intervention Research Programme

national brief intervention research consortium

Paolo Deluca, PhDInstitute of PsychiatryKing’s College London

Programme design• 3 cluster randomised clinical trials (PHC, AED,

CJS) to assess– What are the barriers/facilitators to

implementation in a “typical setting”– Identify most effective screening approach/tool– Most effective and cost effective intervention

approach• Common measures and design to allow

comparisons

PHC study• 24 PHC practices, 3 regions (NE, London, SE)• 4 screening approaches (universal vs targeted, M-SASQ vs FAST)

Targeted: New registrations, Injuries, Hypertension, Gastrointestinal problems, Mental health problems

• 3 intervention approaches– Patient information leaflet (DH - How much is too much?)– Brief advice (5 min)– Brief Lifestyle Counselling (20 min)

• 744 patients (31 each)• Incentives (research, clinical)• Baseline research interview• 6 & 12 month follow-up research interview• Attitudes, barriers and facilitators

PHC Research progress update• Recruited 24 (+8) practices• Trained 189 staff (nurses and GPs)• Recruiting participants since May 08• 497 (66.8%)• 6 GPs completed recruitment, 9 about to end• 7 under performing and 2 dropped out• 2 agreed to carry on

Approached Eligible ScreenedPositive Consented

PHC 2280 1858 1858 532 444

% 81.5 81.5 28.6 83.5

Training PHC staff• On site training to small groups delivered by RA & AHW • 1 to 2 hrs for screening and BA including role play• 1 to 2 sessions for BLC training with actors in PHC• Overall positive feedback on training• Research elements and Alcohol Units are usually the

challenging parts of the training• Most welcomed receiving training and being assessed• 1 session with actor was enough for all but one practice• But adequate space, staff availability, time and

implementation issues slowed the training stage

PHC Implementation issues• Protocol: Leaflet-eligibility-screening-informed

consent-baseline-intervention• Ideally delivered by same person (except BLC)• In practice we implemented various models to fit

local needs and resources (10 min slots)• Strong local lead (champion)• N of staff involved (all vs just a few)• Low recruitment/positives in same areas (eg

Enfield)• After good start, patients re-attending slowed

recruitment

AED study• 9 AEDs, 3 regions (NE, London, SE)• 3 screening approaches (M-SASQ, PAT, FAST)• 3 intervention approaches– Patient information leaflet– Brief advice (5 min)– Referral to Alcohol Health Worker BLC (20 min)

• 1,179 patients (131 each)• Baseline research interview• 6 & 12 month follow-up research interview• Attitudes, barriers and facilitators

A&E Research progress update• Recruited 9 (+2) A&Es• Trained 250 staff (nurses and consultants)• Recruiting participants since April 08• 717 (60.8%)• 1 A&E completed recruitment, 3 about to end• All underperforming

Approached Eligible ScreenedPositive Consented

A&E 3230 2155 2110 788 679

% 66.7 65.3 37.3 86.2

Training A&E staff• On site training to small and large groups delivered by

RA & AHW • 1 to 2 hrs for screening and BA including role play• No BLC training• Overall positive feedback on training. Research

elements and Units are usually the challenging parts of the training

• Most welcomed receiving training• Adequate space, staff availability, “on call”, turnover,

time and implementation issues slowed training• Booster sessions, launch events, shadowing staff first

few weeks

A&E Implementation issues• Protocol: Leaflet-eligibility-screening-informed

consent-baseline-intervention• Ideally delivered by same person (except BLC) in

practice divided by triage/nurses and doctors• Strong local lead (champion)• Consent and contact details put some participants off• Workload• Staff turnover (eg August)• Easily forget training if start is delayed• Tendency of targeting dependent drinkers• Weekly support

CJS study• 96 offender managers, 18 offices• 3 regions (NE, London, SE)• 2 screening tools (FAST, M-SASQ)• 3 interventions– Leaflet– Brief advice (5 min)– Brief Lifestyle Counselling by Alcohol Health Worker

• 480 participants (5 each)• Follow-up 6 & 12 months• Attitudes, barriers and facilitators

CJS Research progress update• Recruited 96 (+11) Offender Managers from 18

probation offices• Trained 131 OMs (some disappeared after training)• Recruiting participants since June 08• 151 (31.5%)• 17 OMs completed recruitment, 10 about to end,

remainder underperforming-struggle to start, 24 dropped out/left

Approached Eligible ScreenedPositive Consented

CJS 304 250 250 164 141

% 82.2 82.2 65.6 86.0

Training CJS staff• On site 1 to 1 training delivered by RA & AHW • 1 to 2 hrs for screening and BA including role play• No BLC training• Overall positive feedback on training. Research

elements (informed consent) and ulcohol units are usually the challenging parts of the training

• Not very enthusiastic, most drawn into it from line manager.

• Adequate space, staff availability (1to1), turnover, slowed training

• Booster sessions, shadowing staff first few weeks

CJS Implementation issues• Protocol: Leaflet-eligibility-screening-informed

consent-baseline-intervention• Delivered by same person (except BLC)• No strong local lead (champion)• Consent and contact details put some participants

off• Workload• North/South divide• Staff not engaging with SIPS team• Easily forget training if start is delayed• Weekly support, further incentives?

Training tools and methods

List of tools– M-SASQ– FAST– SIPS-PAT– AUDIT– Screening training– PIL– Brief Advice (BA)– BA Training– Brief Life Style

Counselling (BLC)

– BLC training– BLC Demo video– Actors’ scripts– Staff pre-training

questionnaire– Staff post-training

questionnaire– BECCI + Manual– Training manual

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Websitewww.sips.iop.kcl.ac.uk & Alcohol Learning Centre

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Training and intervention tools

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Recruitment by month

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Changes to improve recruitment

• Deployment of our AHWs in A&Es• Additional GP surgeries to complement the

underperforming ones• Additional offender managers to complement

the underperforming ones• Extra support to offender managers• Allow over-recruitment in CJS and PHC

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Conclusions

• Prevalence of AUDs reflect previous studies in these settings

• Patients/clients are more willing to receive an intervention than previous studies

• Overall staff in these settings are keen to be trained

• However, limited time, workload and turnover are limiting implementation