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Screening and Intervention Programme for Sensible Drinking (SIPS) National Brief Intervention Research Consortium A&E St. Marys 'Scientia Vincit Timorem'

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Presentation on theme: "Screening and Intervention Programme for Sensible Drinking (SIPS) National Brief Intervention Research Consortium A&E St. Marys 'Scientia Vincit Timorem'"— Presentation transcript:

1 Screening and Intervention Programme for Sensible Drinking (SIPS) National Brief Intervention Research Consortium A&E St. Marys 'Scientia Vincit Timorem'

2 Training Objectives Content of this session: Pre-Training Staff Survey Part 1: Background to the study: Alcohol prevalence, effects and issues in England Hazardous/harmful drinking The AED Trial Alcohol screening and brief interventions The SIPS programme Parts 2 : Triage Stage Provide you with the knowledge and skills to: Implement study procedures in accordance with the protocol Introduce the study and gain verbal consent Administer and score the screening questionnaire (FAST) Part 3: Treating Clinician Stage Obtain consent and check baseline questionnaire Understand requirements of patients involved in the study Part 4 : Clinical interventions training Post-Training Staff Survey

3 Staff survey This is a short survey on your attitudes towards alcohol screening/brief interventions and relevant pre-training experience This is a short survey on your attitudes towards alcohol screening/brief interventions and relevant pre-training experience Your feedback on the experience of alcohol screening and brief interventions will make an important contribution to the study Your feedback on the experience of alcohol screening and brief interventions will make an important contribution to the study We will ask you to complete the same questionnaire after the training session, and once again after recruitment to the study has been complete We will ask you to complete the same questionnaire after the training session, and once again after recruitment to the study has been complete Please read through the Information Sheet and sign two copies of the consent form if you agree to fill it in. Please read through the Information Sheet and sign two copies of the consent form if you agree to fill it in.

4 Part 1 – Background

5 What do you think constitutes an alcohol problem?

6 Alcohol Use Definitions Low-risk drinking - below medically recommended limits (2-3 units per day for women; 3-4 units per day for men, with at least two alcohol free days a week) Low-risk drinking - below medically recommended limits (2-3 units per day for women; 3-4 units per day for men, with at least two alcohol free days a week) Hazardous drinking - a pattern of consumption which increases the risk of harm (physical, psychological or social), i.e., drinking above recommended limits Hazardous drinking - a pattern of consumption which increases the risk of harm (physical, psychological or social), i.e., drinking above recommended limits Harmful drinking - a pattern which is likely to have already led to harm (physical, psychological or social) or, for some purposes, drinking at very heavy levels Harmful drinking - a pattern which is likely to have already led to harm (physical, psychological or social) or, for some purposes, drinking at very heavy levels Binge drinking – originally episodic heavy drinking but now heavy drinking in a single session, i.e., twice the daily limit, above 6 units for women 8 units for men Binge drinking – originally episodic heavy drinking but now heavy drinking in a single session, i.e., twice the daily limit, above 6 units for women 8 units for men Alcohol dependence – a cluster of physiological, behavioural and cognitive phenomena conforming to the alcohol dependence syndrome Alcohol dependence – a cluster of physiological, behavioural and cognitive phenomena conforming to the alcohol dependence syndrome

7 Alcohol use disorders: prevalence 26% of the adult population have an alcohol use disorder (AUD) 26% of the adult population have an alcohol use disorder (AUD) Includes 38% of men & 16% of women aged Includes 38% of men & 16% of women aged % of the adult population are hazardous or harmful alcohol users (7.1 million people in England) 23% of the adult population are hazardous or harmful alcohol users (7.1 million people in England) 21% of men and 9% of women engage in binge drinking 21% of men and 9% of women engage in binge drinking

8 Percentage of people in England with an alcohol use disorder by age

9 Alcohol-related harm: acute Homicide Homicide Suicide Suicide Other intentional injuries (i.e., interpersonal violence) Other intentional injuries (i.e., interpersonal violence) Domestic violence Domestic violence Sexual assault Sexual assault Unprotected sex Unprotected sex Motor vehicle accidents Motor vehicle accidents Other accidents Other accidents Drowning Drowning Burns Burns Public disorder Public disorder

10 Alcohol-related harm: chronic Liver cirrhosis and other forms of alcohol- related liver disease Liver cirrhosis and other forms of alcohol- related liver disease Hypertension Hypertension Cancers of the mouth, larynx, pharynx and oesophagus Cancers of the mouth, larynx, pharynx and oesophagus Other cancers, including breast cancer Other cancers, including breast cancer Foetal Alcohol Syndrome (FAS) and foetal alcohol effects Foetal Alcohol Syndrome (FAS) and foetal alcohol effects Mental illness Mental illness Alcohol Dependence Syndrome Alcohol Dependence Syndrome

11 Alcohol-related harm: social problems Lower workplace productivity Lower workplace productivity Unemployment Unemployment Family & social networks Family & social networks Homelessness Homelessness Economic costs Economic costs

12 Alcohol and AEDs 24 hour prevalence survey of alcohol-related attendances at 32 AEDs in England 40% of AED attendances are alcohol related Between midnight and 5am this number increases to 70% Reasons for alcohol related attendance were significantly more commonly: a violent assault incident involving weapons road traffic accidents psychiatric emergencies deliberate self harm episodes

13 St Marys AED Trial Screening and Brief Interventions for alcohol misuse in an accident & emergency department is: Screening and Brief Interventions for alcohol misuse in an accident & emergency department is: feasible feasible associated with lower levels of alcohol consumption over the following 6 months associated with lower levels of alcohol consumption over the following 6 months reduces reattendance reduces reattendance Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the AED over the following 12 months Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the AED over the following 12 months For every 2 patients referred to an AHW there is one less reattandence in the following year! For every 2 patients referred to an AHW there is one less reattandence in the following year!

14 Costs/Benefits Screening and referral to the AHW has a cost, but this should be offset against the savings gained by reducing attendance Screening and referral to the AHW has a cost, but this should be offset against the savings gained by reducing attendance For every 1000 patients screened, costs are approximately £2500 (including the cost of the AHW for those referred), and savings of £4000 For every 1000 patients screened, costs are approximately £2500 (including the cost of the AHW for those referred), and savings of £4000 Net: £1500 savings Net: £1500 savings

15 Screening for hazardous & harmful drinking Screening is necessary to detect risky drinkers whose level of consumption may not be apparent Screening is necessary to detect risky drinkers whose level of consumption may not be apparent Short questionnaires are the most efficient way of screening Short questionnaires are the most efficient way of screening Screening for hazardous/harmful alcohol users, not for dependent drinkers Screening for hazardous/harmful alcohol users, not for dependent drinkers

16 What is brief alcohol intervention? … the giving of information, advice and encouragement to the patient to consider the positives and negatives of their drinking behaviour, plus support and help to the patient if they do decide they want to cut down on their drinking. … the giving of information, advice and encouragement to the patient to consider the positives and negatives of their drinking behaviour, plus support and help to the patient if they do decide they want to cut down on their drinking. Brief interventions are usually opportunistic – that is, they are administered to patients who have not attended a consultation to discuss their drinking Brief interventions are usually opportunistic – that is, they are administered to patients who have not attended a consultation to discuss their drinking

17 What is the SIPS Programme A national research consortium led by the Institute of Psychiatry, Kings College London and Newcastle University, with expertise in screening and brief interventions in the alcohol field A national research consortium led by the Institute of Psychiatry, Kings College London and Newcastle University, with expertise in screening and brief interventions in the alcohol field Funded by the Department of Health; £3.2 million, as part of the Alcohol Harm Reduction Strategy for England (2004) Funded by the Department of Health; £3.2 million, as part of the Alcohol Harm Reduction Strategy for England (2004) To investigate the effectiveness and cost effectiveness of alcohol SBI in: To investigate the effectiveness and cost effectiveness of alcohol SBI in: Accident & Emergency Departments Primary Health Care Criminal Justice Services

18 Cluster Randomised Controlled Design Within 3 different regions of England – North East, South East and London, in: Within 3 different regions of England – North East, South East and London, in: 24 Primary Health Care practices; 9 Accident & Emergency Departments; 9 probation offices 24 Primary Health Care practices; 9 Accident & Emergency Departments; 9 probation offices Cluster = 1 AED, 2-3 PHC sites, 1 probation office Cluster = 1 AED, 2-3 PHC sites, 1 probation office Study is comparing the effectiveness of: Study is comparing the effectiveness of: 2 screening approaches (targeted vs. universal) 2 screening approaches (targeted vs. universal) 3 screening tools (M-SASQ; SIPS-PAT; FAST) 3 screening tools (M-SASQ; SIPS-PAT; FAST) 3 brief interventions (PIL; Brief Advice; Brief Lifestyle Counselling) 3 brief interventions (PIL; Brief Advice; Brief Lifestyle Counselling) ??????????? has been assigned: ??????????? has been assigned: ???????? Screening; ?????; ????????? ???????? Screening; ?????; ????????? 131 Patients to be recruited at this site 131 Patients to be recruited at this site

19 Objectives of the AED Trial Identify best screening tool Identify best screening tool Compare effectiveness and cost effectiveness of different models of brief intervention Compare effectiveness and cost effectiveness of different models of brief intervention Assess implementation of different screening and brief intervention (SBI) approaches by staff Assess implementation of different screening and brief intervention (SBI) approaches by staff Identify factors that predict successful implementation of SBI in routine AED care Identify factors that predict successful implementation of SBI in routine AED care

20 Summary of SIPS in your AED Assess patient for treatment as normal Brief introduction of study Gain verbal consent to check eligibility and screen Screen for alcohol misuse If negative end their involvement in the study If positive hand them a study pack Research participant hands over study pack Staff ensures both consent form is signed by the research participant and then countersigns the forms, giving the patient a copy of this to take away with the information sheet. Check baseline survey is completed Issue patient information leaflet and conduct brief structured advice Store study pack in secure place for SIPS research staff to collect Triage Stage: Treating Clinician Stage: Research participant hands over study pack Staff ensures both consent forms are signed by the research participant and then countersigns the forms, giving the patient a copy to retain along with the information sheet. Check baseline survey is completed Conduct Brief Advice and issue Patient Information Leaflet Store study pack in secure place for SIPS research staff to collect Patient in waiting room to read study pack including: the research participant information sheet, sign both copies of the consent form if they are happy to participate and complete the baseline survey.

21 Part 2 – Triage Stage

22 Participant Baseline Questionnaire - AED

23 Introducing the study We are currently working with a team of researchers led by the Institute of Psychiatry, who are conducting a study on behalf of the Department of Health. The aim of the study is to find out how to provide help to people who are drinking alcohol in ways that might be harming their health. Would you mind if I asked you a few questions to see if you meet the eligibility criteria to take part in the study, and if you do I would then like to ask you a few questions about your drinking in the last six months. Would this be ok? We are currently working with a team of researchers led by the Institute of Psychiatry, who are conducting a study on behalf of the Department of Health. The aim of the study is to find out how to provide help to people who are drinking alcohol in ways that might be harming their health. Would you mind if I asked you a few questions to see if you meet the eligibility criteria to take part in the study, and if you do I would then like to ask you a few questions about your drinking in the last six months. Would this be ok?

24 Eligibility criteria The patient: Is aged 18 or over i.e. the ability to understand the information presented, retain it and make an informed decision – competence Is alert and orientated i.e. the ability to understand the information presented, retain it and make an informed decision – competence Is resident within 20 miles Is able to speak, read and write English sufficiently well to take part in the study Recruiting patients to participate

25 Eligibility continued... Is not severely injured Is not suffering with a serious mental health problem e.g. acute psychotic episode or severely distressed Is not grossly intoxicated Is not currently seeking help for alcohol problems Is not involved in any other alcohol research study Has a fixed abode Has provided verbal consent to be screened

26 Patient demographic information

27 What is a standard unit of alcohol? The alcohol screening process

28 Fast Alcohol Screening Test (FAST)

29 Examples: Fast Alcohol Screening Test (FAST) Most Fridays after work I usually have a couple of pints of Guinness, and then share a bottle of wine over dinner with my wife, followed by a whisky. Example 1: In response to question 1 of the FAST, the man says: 1.Calculate the number of standard drinks that the man had: 4 (Guinness) (wine) + 1 (whisky) = 9.5+ standard drinks 2.How would you record and score the answer to this question using the FAST? More than 8 standard drinks every week = weekly 3.Why would you not continue with the remaining 3 questions? He has more than 8 units on one occasion every week = positive. Therefore no need to ask any more questions

30 Examples: Fast Alcohol Screening Test (FAST) I normally have a couple of glasses of wine when I go out, but on my birthday I will get through a whole bottle! Example 2: In response to question 1 of the FAST, the woman says: In response to question 2 she says: Only a couple times in the last six months... 1)How would you score question 1 on the fast? Less than monthly = not necessarily positive but scores 1 point and you need to ask the other questions 2)How would you record her response on the FAST? Less than monthly = 1 point

31 Examples: Fast Alcohol Screening Test (FAST) A few times I have missed a class at the gym because of the heavy night before. But this has happened very occasionally – definitely less than monthly. Example 2 (continued): In response to question 3 she says: In response to question 4 she says: Nobody has ever expressed any concern about my drinking habits or suggested that I cut down. 3)How would you record this response? Less than monthly = 1 point 4) How would you record this response? No = 0 points 5) Would she screen positive or negative using the FAST? She has 3 points in total so she would be positive

32 Examples: Fast Alcohol Screening Test (FAST) I have a can of beer every evening and then 3 pints when I watch my team play football Example 3: In response to question 1 of the FAST, a man says: 1.Calculate the number of standard drinks that the man had: 3 pints = 6 – 9 standard drinks depending on strength of beer 2.How would you record and score the answer to this question using the FAST? Need to ask him how often he watches his team and type of beer he drinks. To which he says: The wife only lets me out once a month so I only get to watch my team about once a month. I always drink Stella.

33 Examples: Fast Alcohol Screening Test (FAST) Only on my stag night 8 years ago! In response to question 2 of the FAST, the man says: 3.How would you score his response for question 1 of the FAST? 3 pints Stella = 9 standard drinks one a month: answer would be monthly. 4.What next? He might not be positive so you give him 2 points and ask the other 3 questions. 5.How would you score his response for question 2 of the FAST? Never = 0 points. He therefore still only has 2 points.

34 Examples: Fast Alcohol Screening Test (FAST) 6.How would you score his response on question 3 of the FAST? Never = 0 points. He therefore still only has 2 points. Its never stopped me doing anything as far as I remember. In response to question 3 of the FAST, the man says: No, never. In response to question 4 of the FAST, the man says: 7.How would you score his response on question 4 of the FAST? Never = 0 points. Again he still only has 2 points. 8.Would he screen positive or negative? He has only 2 points overall and is negative.

35 SIPS Modified Paddington Alcohol Test (SIPS-PAT)

36 Examples: SIPS-PAT No it was the heels on these new shoes. Example 1: A woman presents to the A&E department with injuries from a fall so you screen her using the SIPS-PAT. You ask her if she feels her attendance here is related to her drinking. The woman responds: So what do you do? It was not drinking related so you go on to ask the woman question 2 of the SIPS- PAT and you ask her how often she has 6 or more drinks on one occasion. She replies:

37 Examples: SIPS-PAT When I go out after work I usually have a couple of single vodkas, at the weekend maybe a bit more, say 4 or 5 single vodkas. But never more than that on one occasion. Example 1 (continued): 1) Calculate the number of standard drinks the woman has. 4 – 5 standard drinks 2) What box would you cross in question 2? Never 3) Would she screen negative or positive using the SIPS-PAT? Negative

38 Examples: SIPS-PAT No, it isnt to do with drink, I tripped on an uneven pavement and hit my head. Example 2: A man comes into the A&E department with head injuries so you screen him using the SIPS-PAT. You ask him if he feels his attendance here is related to his drinking. The man responds: 1) So what do you do? It was not drinking related so you go on to ask the man question 2 of the SIPS- PAT and you ask him how often he has 6 or more drinks on one occasion. He replies:

39 Examples: SIPS-PAT I go out to the pub most weeks and I usually only drink about 3 pints, very rarely more than that. Example 2 (continued): 2)Calculate the number of standard drinks the man has. 6 standard drinks if regular strength beer but more if strong/premium strength so you ask him what pints he normally drinks, he replies: Kronenbourg, if theyve got it.

40 Examples: SIPS-PAT Example 2 (continued): 3)Taking into account this new information recalculate the number of standard drinks the man has. 9 standard drinks 4)What box would you cross in question 2? Weekly 5)Would he screen negative or positive using the SIPS-PAT? Positive

41 Examples: SIPS-PAT No I fell off a ladder whilst decorating Example 3: A man presents to the A&E department with injuries from a fall so you screen him using the SIPS-PAT. You ask him if he feels his attendance here is related to his drinking. The man responds: So what do you do? It was not drinking related so you go on to ask the man question 2 of the SIPS- PAT and you ask him how often he has 8 or more drinks on one occasion. He replies:

42 Examples: SIPS-PAT I usually go out after work and have a couple of pints of Stella and 2 double whiskey and cokes. Example 3 (continued): 1) Calculate the number of standard drinks the man has. 2 pints of Stella = 6 standard drinks; Whisky = 4 standard drinks 2) What box would you cross in question 2? Weekly 3) Would he screen negative or positive using the SIPS-PAT? Positive

43 Modified Single Alcohol Screening Questionnaire (M-SASQ)

44 Examples: M-SASQ Example 1: In response to the M-SASQ question, the man says: I normally have a glass of wine with dinner most nights, but on a Saturday I have a whole bottle. 1) Calculate the number of standard drinks the man consumes. 1-2 units per day and 9 at the weekend 2) What response would you give him on the M-SASQ? weekly 3) Would he screen negative or positive using the M-SASQ? positive

45 Examples: M-SASQ Example 2: In response to the M-SASQ question, the woman says: I usually drink about 3 or 4 pints on a Friday night after work, but never more than this. 1) Calculate the number of standard drinks the woman has. 6 – 12 standard drinks (depending whether ordinary or strong beer) 2) What response would circle on the M-SASQ? Weekly 3) Would she screen negative or positive using the M-SASQ? Positive

46 Examples: M-SASQ Example 3: In response to the M-SASQ question, a man says: I have about 4 beers a night and about 8 on a Saturday night. After all mans not a camel! 1) Calculate the number of standard drinks the man consumes. 4 beers = 8+ units; 8 beers = 16+; Total = 24+ per week 2) What response would you give him on the M-SASQ? Daily 3) Would he screen negative or positive using the M-SASQ? Positive

47 Screening Results If patient is negative, thank them for their interest in the study and terminate their involvement at this point If patient is negative, thank them for their interest in the study and terminate their involvement at this point If patient is positive, provide with Research Participant Information Sheet and attempt to obtain written consent If patient is positive, provide with Research Participant Information Sheet and attempt to obtain written consent

48 Issuing Research Participant Information Sheet I have looked over the results of your questionnaire, and from your answers it appears that you may be drinking at a rate that increases your risk of harm. The research team are trying to find ways of helping people who may be drinking in ways that are harmful to health. They would like about 10 minutes of your time to help with their research, by completing a short questionnaire for which you will receive a £10 voucher. You will then receive an information leaflet [about alcohol] / and 5 minutes brief advice about alcohol/ and we will arrange an appointment for you to see an Alcohol Health Worker to discuss your drinking further (delete as appropriate) The research team will contact you again in 6 months and 12 months to complete another short questionnaire, for which you will receive another £10 voucher for each time. Please take the time to read this information leaflet carefully, and feel free to ask any questions you wish. I have looked over the results of your questionnaire, and from your answers it appears that you may be drinking at a rate that increases your risk of harm. The research team are trying to find ways of helping people who may be drinking in ways that are harmful to health. They would like about 10 minutes of your time to help with their research, by completing a short questionnaire for which you will receive a £10 voucher. You will then receive an information leaflet [about alcohol] / and 5 minutes brief advice about alcohol/ and we will arrange an appointment for you to see an Alcohol Health Worker to discuss your drinking further (delete as appropriate) The research team will contact you again in 6 months and 12 months to complete another short questionnaire, for which you will receive another £10 voucher for each time. Please take the time to read this information leaflet carefully, and feel free to ask any questions you wish.

49 AED Research Participant Information Sheet

50 Part 3 – Treating Clinician Stage

51 Consent Patient will hand baseline pack to clinician who will check consent form. Patient will hand baseline pack to clinician who will check consent form. Informed consent is an agreement entered into with complete knowledge of all relevant facts. Informed consent is an agreement entered into with complete knowledge of all relevant facts. Ensure they have read through the consent form and signed both copies. Ensure they have read through the consent form and signed both copies. If they consent make sure you countersign both copies and detach patient copy. If they consent make sure you countersign both copies and detach patient copy.

52 Consent Forms

53 Consent If the patient does not consent to participate in the study, offer them the Patient Information Leaflet and no further action is taken. If the patient does not consent to participate in the study, offer them the Patient Information Leaflet and no further action is taken.

54 Instructions to patients

55 Patient personal information sheet

56 Alcohol Use Disorders Identification Test (AUDIT)

57 EQ5D – health status questionnaire

58 Service Use Questionnaire (SUQ)

59 Readiness to Change Ruler (RCR)

60 Please check participants have filled in all sections of the baseline questionnaire!

61 Patient Information Leaflet How Much Is Too Much?

62 The Principles of the PIL an intervention in itself an intervention in itself contains useful information regarding personal alcohol use contains useful information regarding personal alcohol use is not confrontational or judgmental. is not confrontational or judgmental. free resource for people to take away free resource for people to take away easy to read format easy to read format

63 How to issue the Patient Information Leaflet (PIL) Brief Advice and the PIL must be delivered in the same manner for each patient.Brief Advice and the PIL must be delivered in the same manner for each patient. When handing over the PIL please say:When handing over the PIL please say: Thank the patient, inform them they will receive a letter from the research team in 2 weeks that will contain a £10 voucher.Thank the patient, inform them they will receive a letter from the research team in 2 weeks that will contain a £10 voucher. This leaflet describes what we have just discussed in more detail. Please take this away and read through it. There are contact details on the back should you need further help/advice.This leaflet describes what we have just discussed in more detail. Please take this away and read through it. There are contact details on the back should you need further help/advice.

64 Pilot Days An opportunity to practice screening and providing Brief Advice An opportunity to practice screening and providing Brief Advice Triage nurse to screen patients and refer those positive to the study doctors/ENPs Triage nurse to screen patients and refer those positive to the study doctors/ENPs Doctors/ENPs will have a go at offering the Brief Advice Doctors/ENPs will have a go at offering the Brief Advice No research materials will be used No research materials will be used Ensures potential problems can be solved before active recruitment to study begins Ensures potential problems can be solved before active recruitment to study begins Sam, Malcolm and Lisa will be on site during pilot for support and feedback Sam, Malcolm and Lisa will be on site during pilot for support and feedback

65 Winchester Flow Chart

66 Support and supervision Who to contact if Im worried about a patient in the study? Please contact your alcohol health worker: Lisa Rail Julia Reid Tel: Tel: Or refer patients to alcohol services as outlined in the Patient Information Leaflet: Drinkline Tel: Alcoholics Anonymous Tel: Alternatively instruct the patients to contact their GP for referral to local alcohol services Who do I contact if Im worried about the research processes? In the first instance please contact your designated member of the research team: Sam KeatingMalcolm Hobbs Tel: Tel: Katherine Perryman Tel:

67 Useful links


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