High Impact Changes

High Impact Changes

• Prioritize alcohol within LAAs and NHS Operating Framework – Vital Signs

• Improve treatment• Review pathways and access – NATMS• Evidence based practice – Models of Care

• Implement IBA• Health: A&E, Clinics, GPs• Criminal Justice

• Develop activities to control alcohol misuse • Identify local champions & build the case for investment• Provide local implementation of national media

campaigns

Mental Health

1. Treat home based care and support as the norm

2. Improve access to screening and assessment

3. Manage variation in service user discharge processes

4. Manage variation in access to all mental health services

5. Avoid unnecessary contact 6. Increase the reliability of

interventions7. Apply a systematic approach 8. Improve service user flow by

removing queues9. Use an integrated care pathway

approach10. Retain an effective workforce

Social Care

1) involvement

2) dignity and respect

3) meeting fundamental needs

4) accessible information and support

5) partnership working

6) personalised services

7) effective commissioning

8) flexibility/challenge/creativity

9) inclusion, and

10) carers as partners in care

Tobacco

1. Work in partnership 2. Gather and use the full range of data

to inform tobacco control 3. Use tobacco control to tackle health

inequalities4. Deliver consistent, coherent and co-

ordinated communication5. An integrated stop smoking approach6. Build and sustain capacity in tobacco

control7. Tackle cheap and illicit tobacco8. Influence change through advocacy9. Helping young people to be tobacco

free10.Maintain and promote smoke-free

environments

Excellence in tobacco control:10 High Impact Changes toachieve tobacco controlAn evidence-based resource for local AlliancesPrepared by the Tobacco Control National Support Team, May 2008

High Impact Changes

• Prioritize alcohol within LAAs and NHS Operating Framework – Vital Signs

• Improve treatment• Review pathways and access – NATMS• Evidence based practice – Models of Care

• Implement IBA• Health: A&E, Clinics, GPs• Criminal Justice

• Develop activities to control alcohol misuse • Identify local champions & build the case for investment• Provide local implementation of national media

campaigns

High Impact Changes

• Prioritize alcohol within LAAs and NHS Operating Framework – Vital Signs

• Improve treatment• Review pathways and access – NATMS• Evidence based practice – Models of Care

• Implement IBA• Health: A&E, Clinics, GPs• Criminal Justice

• Develop activities to control alcohol misuse • Identify local champions & build the case for investment• Provide local implementation of national media

campaigns

Point of Clarification

• Opportunistic alcohol case Identification and the

delivery of Brief Advice (IBA)

is the same as

• Screening and Brief Interventions for alcohol

misuse (SBI)

Evidence for IBA

• There is a very large body of research evidence • 56 controlled trials (Moyer et al., 2002) all have shown

the value of IBA • A recent Cochrane Collaboration review (Kaner et al.,

2007) shows substantial evidence for IBA effectiveness • For every eight people who receive simple alcohol

advice, one will reduce their drinking to within lower-risk levels (Moyer et al., 2002)

• This compares favourably with smoking where only one in twenty will act on the advice given (Silagy & Stead, 2003) – This improves to one in ten with nicotine replacement

therapy.

Benefits of IBA• IBA would result in the reduction from higher-risk to lower-risk

drinking in 250,000 men and 67,500 women each year (Wallace et al, 1988).

• Higher risk and increasing risk drinkers who receive brief advice are twice as likely to moderate their drinking 6 to 12 months after an intervention when compared to drinkers receiving no intervention (Wilk et al, 1997).

• Brief advice can reduce weekly drinking by between 13% and 34%, resulting in 2.9 to 8.7 fewer mean drinks per week with a significant effect on recommended or safe alcohol use (Whitlock et al, 2004).

• Reductions in alcohol consumption are associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure (Miller et al, 2005).

• Brief advice on alcohol, combined with feedback on CDT levels, can reduce alcohol use and %CDT in primary care patients being treated for Type 2 diabetes and hypertension (Fleming et al, 2004).

The Numbers

FACTS FIGURES

PCTs 152

Inc + High % 22.6

Dep % 3.6

Practices 8,261

GPs 33,364

  ENGLAND PCT PRACTICE GP

Total Population

53,588,218

352,554

6,487

1,606

Adult Population

43,580,873

286,716

5,275

1,306

Dependent drinkers

1,568,911 10,322

190

47

Increased and High Risk

9,849,277 64,798

1,192

295

IBA in A&E

• A study at St Mary’s Paddington showed that patients who received an intervention (Crawford et al, 2004):– Were drinking at significantly lower levels– Made 0.5 fewer visits to A&E

• A study in Liverpool supports having an alcohol liaison nurse in A&E working into the hospital. It suggests the post saved 40 admissions per year - much more than its cost (Royal College of Physicians, 2001)

Treatment

• Dependent drinkers cost the NHS double the cost of lower-risk drinkers

• Dependent drinkers represent a very high-risk group for hospital admissions

• UK Alcohol Treatment Trials (UKATT)– SBNT & MET– 25% successful outcome – no alcohol-related

problems– 40% much improved – reduced problems by 66%