We have funded a wide range of studies that support the implementation of screening and brief interventions within Primary Care as well as Accident and Emergency and Maxillofacial departments.
A very widely used screening test for alcohol misuse is the Alcohol Use Disorders Identification Test (AUDIT), which was developed in a World Health Organisation collaborative project across six countries. Although AUDIT has been well validated there are some situations, such as busy clinics as and Accident and Emergency departments, where AUDIT takes too long to administer routinely.
Joint funding from the HEA and Alcohol Research UK led to the development of the Fast Alcohol Screening Test (FAST) which is now being used by many doctors’ clinics and A&E departments. It is the Screening Instrument of choice in a recently published book entitled: Nursing Practice: Hospital and Home. Compared with other tests it is quicker and very easy to incorporate into a medical interview. It works equally well in different medical settings including primary care, dental hospitals and fracture clinics and for different age and gender groups. The FAST is now one of the top rated screening instruments.
Maxillo-facial surgeons see a regular stream of young male casualties in A&E departments with alcohol related facial injuries often incurred as a result of fighting. They receive appropriate treatment and are given an appointment for a follow-up clinic within the next 10 days. Can advice given at this point, when young men are concerned about their good looks, influence future alcohol consumption? We funded a brief intervention Study to look at this possibility. The motivational intervention lasted for less than twenty minutes and was given by the nurse as she removed stitches. Even though this intervention was very brief, and the cost to the NHS was negligible, it resulted in a significant change in alcohol consumption during the following year when compared to ‘treatment as usual.’ There was a reduction of 55% in the number of young men drinking over the recommended limits compared to a drop of 8% in the comparison group. A brief dialogue, completed between a nurse and a patient as part of a routine service without the need for additional resources or additional time proved highly effective.
The next Study completed with Alcohol Research UK funding looked at the best way to train nurses to carry out screening and brief interventions. This training study, A randomised controlled trial of training and support strategies to encourage screening and brief alcohol intervention completed by Eileen Kaner, Nick Heather and their colleagues evaluated the impact on implementation of providing nurses with a) written guidelines, b) guidelines plus practice-based training or c) guidelines plus training and ongoing telephone support.
This Study showed that primary care nurses are certainly interested in screening and brief alcohol interventions with many of them willing to incorporate this approach into practice. But simply giving nurses intervention materials with written guidelines alone was not sufficient. Skill-based training was the most effective and cost-effective approach.
Referrals By A&E Departments
Accident and Emergency departments see a large number of patients who misuse alcohol. Alcohol Research UK therefore funded a Study called Referral for alcohol misuse in an emergency department: Results of a randomised trial which has had a significant impact on practice and policy. After screening, those who were referred on to an alcohol health worker were drinking less at follow up. At six months they were drinking 23 units of alcohol a week less than those given an information leaflet: at twelve months the difference was 14 units. Furthermore those referred to the alcohol health worker had on average fewer visits to the Accident and Emergency Department over the following 12 months. Attendance at an AED provides a ‘teachable moment’ in which opportunistic identification of alcohol misuse can potentially help patients develop insight into the consequences of their drinking and promote improved overall health.
This programme of work on brief interventions by Alcohol Research UK is widely quoted in policy documents, e.g. Alcohol Misuse Interventions: Guidance on developing a local programme of improvement (p36 – 40).
Training in brief interventions for alcohol problems should be as important in medical and nursing training as interventions for diabetes or high blood pressure