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Eileen Kaner,
Martin Bland,
Paul Cassidy,
Simon Coulton,
Veronica Dale,
Paolo Deluca,
Eilish Gilvarry,
Christine Godfrey,
Nick Heather,
Judy Myles,
Dorothy Newbury-Birch,
Adenekan Oyefeso,
Steve Parrott, Katherine Perryman,
Tom Phillips,
Jonathan Shepherd,
Colin Drummond
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ABSTRACT: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking.
Pragmatic cluster randomised controlled trial.
Primary care practices in the north east and south east of England and in London.
3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers.
Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation.
The primary outcome was patients' self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients' motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler.
Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings.
All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking.
Current Controlled Trials ISRCTN06145674.
BMJ (Clinical research ed.). 01/2013; 346:e8501.
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Katherine Perryman,
Abigail K. Rose,
Hannah Winfield,
Jenny Jenner,
Adenekan Oyefeso,
Tom S. Phillips,
Paolo Deluca,
Charlie Heriot-Maitland,
Sue Galea,
Survjit Cheeta,
Vivienne Saunders,
Colin Drummond
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ABSTRACT: Background: Although there is currently a high level of need for alcohol treatment in the United Kingdom, there has been a lack of research into alcohol treatment to date. This study reports on what the current challenges to alcohol treatment services in England are, what resources might help to improve services, and which groups are poorly served by alcohol treatment services, as perceived by service providers. Methods: Qualitative data was obtained in three open-ended questions from a sample of 207 alcohol treatment agencies that responded to the national alcohol needs assessment postal survey. Results: Lack of funding, a general lack of resources to provide services, inadequate access to detoxification and rehabilitation services, and a lack of trained staff to deliver services were key challenges presented. More staff, improved access to detoxification and rehabilitation services, better premises, more funding allocation, improved links with other services, and better resources in general to provide services were the key factors reported to improve services. Clients with complex needs (e.g., dual diagnosis, brain damage), women with children, homeless people, and ethnic minorities were perceived to be poorly served by alcohol treatment services. Conclusions: Alcohol treatment services in England face many challenges which should be incorporated into future alcohol treatment service development.
12/2010; 16(1):38-49.
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Dorothy Newbury-Birch,
Martin Bland,
Paul Cassidy,
Simon Coulton,
Paolo Deluca,
Colin Drummond,
Eilish Gilvarry,
Christine Godfrey,
Nick Heather,
Eileen Kaner,
Judy Myles,
Adenekan Oyefeso,
Steve Parrott, Katherine Perryman,
Tom Phillips,
Don Shenker,
Jonathan Shepherd
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ABSTRACT: A large number of randomised controlled trials in health settings have consistently reported positive effects of brief intervention in terms of reductions in alcohol use. However, although alcohol misuse is common amongst offenders, there is limited evidence of alcohol brief interventions in the criminal justice field. This factorial pragmatic cluster randomised controlled trial with Offender Managers (OMs) as the unit of randomisation will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in probation and different intensities of brief intervention to reduce excessive drinking in probation clients.
Ninety-six OMs from 9 probation areas across 3 English regions (the North East Region (n = 4) and London and the South East Regions (n = 5)) will be recruited. OMs will be randomly allocated to one of three intervention conditions: a client information leaflet control condition (n = 32 OMs); 5-minute simple structured advice (n = 32 OMs) and 20-minute brief lifestyle counselling delivered by an Alcohol Health Worker (n = 32 OMs). Randomisation will be stratified by probation area. To test the relative effectiveness of different screening methods all OMs will be randomised to either the Modified Single Item Screening Questionnaire (M-SASQ) or the Fast Alcohol Screening Test (FAST). There will be a minimum of 480 clients recruited into the trial. There will be an intention to treat analysis of study outcomes at 6 and 12 months post intervention. Analysis will include client measures (screening result, weekly alcohol consumption, alcohol-related problems, re-offending, public service use and quality of life) and implementation measures from OMs (the extent of screening and brief intervention beyond the minimum recruitment threshold will provide data on acceptability and feasibility of different models of brief intervention). We will also examine the practitioner and organisational factors associated with successful implementation.
The trial will evaluate the impact of screening and brief alcohol intervention in routine probation work and therefore its findings will be highly relevant to probation teams and thus the criminal justice system in the UK.Ethical approval was given by Northern & Yorkshire REC.
ISRCTN 19160244.
BMC Public Health 11/2009; 9:418. · 2.00 Impact Factor
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Eileen Kaner,
Martin Bland,
Paul Cassidy,
Simon Coulton,
Paolo Deluca,
Colin Drummond,
Eilish Gilvarry,
Christine Godfrey,
Nick Heather,
Judy Myles,
Dorothy Newbury-Birch,
Adenekan Oyefeso,
Steve Parrott, Katherine Perryman,
Tom Phillips,
Don Shenker,
Jonathan Shepherd
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ABSTRACT: There have been many randomized controlled trials of screening and brief alcohol intervention in primary care. Most trials have reported positive effects of brief intervention, in terms of reduced alcohol consumption in excessive drinkers. Despite this considerable evidence-base, key questions remain unanswered including: the applicability of the evidence to routine practice; the most efficient strategy for screening patients; and the required intensity of brief intervention in primary care. This pragmatic factorial trial, with cluster randomization of practices, will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in primary care and different intensities of brief intervention to reduce excessive drinking in primary care patients.
GPs and nurses from 24 practices across the North East (n=12), London and South East (n=12) of England will be recruited. Practices will be randomly allocated to one of three intervention conditions: a leaflet-only control group (n=8); brief structured advice (n=8); and brief lifestyle counselling (n=8). To test the relative effectiveness of different screening methods all practices will also be randomised to either a universal or targeted screening approach and to use either a modified single item (M-SASQ) or FAST screening tool. Screening randomisation will incorporate stratification by geographical area and intervention condition. During the intervention stage of the trial, practices in each of the three arms will recruit at least 31 hazardous or harmful drinkers who will receive a short baseline assessment followed by brief intervention. Thus there will be a minimum of 744 patients recruited into the trial.
The trial will evaluate the impact of screening and brief alcohol intervention in routine practice; thus its findings will be highly relevant to clinicians working in primary care in the UK. There will be an intention to treat analysis of study outcomes at 6 and 12 months after intervention. Analyses will include patient measures (screening result, weekly alcohol consumption, alcohol-related problems, public service use and quality of life) and implementation measures from practice staff (the acceptability and feasibility of different models of brief intervention.) We will also examine organisational factors associated with successful implementation.
Current Controlled Trials ISRCTN06145674.
BMC Public Health 09/2009; 9:287. · 2.00 Impact Factor
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Simon Coulton, Katherine Perryman,
Martin Bland,
Paul Cassidy,
Mike Crawford,
Paolo Deluca,
Colin Drummond,
Eilish Gilvarry,
Christine Godfrey,
Nick Heather,
Eileen Kaner,
Judy Myles,
Dorothy Newbury-Birch,
Adenekan Oyefeso,
Steve Parrott,
Tom Phillips,
Don Shenker,
Jonathan Shepherd
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ABSTRACT: There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption on the physical, psychological and social health of the population. There also exists a substantial evidence base for the efficacy of brief interventions aimed at reducing alcohol consumption across a range of healthcare settings. Primary research conducted in emergency departments has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness. Within this body of evidence there is marked variation in the intensity of brief intervention delivered, from very minimal interventions to more intensive behavioural or lifestyle counselling approaches. Further the majority of primary research has been conducted in single centre and there is little evidence of the wider issues of generalisability and implementation of brief interventions across emergency departments.
The study design is a prospective pragmatic factorial cluster randomised controlled trial. Individual Emergency Departments (ED) (n = 9) are randomised with equal probability to a combination of screening tool (M-SASQ vs FAST vs SIPS-PAT) and an intervention (Minimal intervention vs Brief advice vs Brief lifestyle counselling). The primary hypothesis is that brief lifestyle counselling delivered by an Alcohol Health Worker (AHW) is more effective than Brief Advice or a minimal intervention delivered by ED staff. Secondary hypotheses address whether short screening instruments are more acceptable and as efficient as longer screening instruments and the cost-effectiveness of screening and brief interventions in ED. Individual participants will be followed up at 6 and 12 months after consent. The primary outcome measure is performance using a gold-standard screening test (AUDIT). Secondary outcomes include; quantity and frequency of alcohol consumed, alcohol-related problems, motivation to change, health related quality of life and service utilisation.
This paper presents a protocol for a large multi-centre pragmatic factorial cluster randomised trial to evaluate the effectiveness and cost-effectiveness of screening and brief interventions for hazardous alcohol users attending emergency departments.
ISRCTN 93681536.
BMC Health Services Research 02/2009; 9:114. · 1.66 Impact Factor
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ABSTRACT: The prevalence of alcohol use disorders (AUDs) in the United Kingdom is estimated at 25%, and primary care has been identified as the first line of treatment for this population. However, there is a paucity of evidence regarding the current rates of identification of AUDs in primary care. The aim of the present study was to compare the observed rates of AUDs in general practice with expected rates, which are based on general population prevalence rates of AUDs. DESIGN, PARTICIPANTS AND MEASUREMENTS: Epidemiological data on individuals aged 16-64 years with an AUD was obtained from the General Practice Research Database. General population prevalence rates of AUDs were obtained from the Psychiatric Morbidity Survey. Chi(2) tests and identification ratios were used to analyse the data.
There was a significant relationship between type of AUD and identification (chi(2)=1466.89, P<0.001), and general practitioners were poorer at identifying harmful/hazardous drinkers when compared with dependent drinkers. No gender differences in the identification of hazardous/harmful drinking were found, but female dependent drinkers were significantly more likely to be identified than males (identification ratio 0.07; 95% confidence interval 0.06-0.07). The identification of AUDs was significantly lower for the 16-24-year age group compared with all other age groups.
Despite attempts at targeting hazardous/harmful drinkers for brief interventions in primary care, the present findings suggest that this group are still under-identified. Furthermore, this under-identification is even more apparent in men and in young people who have high general population prevalence rates for AUDs. In conclusion, increasing identification rates could be incorporated into brief intervention strategies in primary care.
Addiction 06/2008; 103(5):766-73. · 4.31 Impact Factor
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Lisa McNally,
Adenekan Oyefeso,
Jan Annan, Katherine Perryman,
Roger Bloor,
Steve Freeman,
Barbara Wain,
Hilary Andrews,
Martin Grimmer,
Arthur Crisp,
Deji Oyebode,
A Hamid Ghodse
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ABSTRACT: Although the move to smoke-free hospital settings is generally a popular initiative, it may be a more challenging and controversial issue in mental health care. A survey was carried out to investigate differences in attitudes between clinical staff in psychiatric and general medical settings to smoke-free policy and intervention.
The sample comprised 2574 NHS staff working in two Acute Hospital Trusts and one Mental Health Trust in England. Attitudes were examined on two factors: health care settings as smoke-free environments and the role of staff in stop smoking intervention.
The findings indicated that attitudes on the two factors were only moderately correlated. Psychiatric staff expressed significantly less favourable attitudes than general staff to smoke-free health care settings and also to the role of staff in stop smoking intervention. The largest difference between the settings concerned the implementation of smoking bans. While approximately 1 in 10 staff in the general setting disagreed with a smoking ban in their wards or clinics, nearly one in three psychiatric staff was against such a ban in their setting.
Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.
Journal of Public Health 10/2006; 28(3):192-6. · 2.06 Impact Factor
