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Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

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Treatment systems; Screening and brief intervention

The most important studies on local, regional and national systems for effectively and cost-effectively implementing screening and brief intervention. One of 25 cells in the alcohol matrix. Also highlights the most useful reviews and practice guidelines and offers a customised one-click search for more on the Effectiveness Bank database.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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K Scottish national implementation drive worked best in primary care (NHS Health Scotland, 2011). Numbers talked to about their drinking testified to what can be done in primary care when national policy is backed by funding, training, resources and per-patient incentive payments. Nevertheless, most risky drinkers were not screened and quality was suspect. Implementation was patchy in antenatal services and emergency departments; more on both settings in document listed below. Discussion in bite’s Highlighted study section.

K In Scotland barriers formidable outside primary care (2015). Experiences of staff who implemented Scotland’s national programme ( above) in emergency departments and ante-natal services. Be prepared to flexibly adapt research-based interventions, seems among the messages for system planners. Discussion in bite’s Highlighted study section.

K Whether conducted in GPs’ surgeries (2013), emergency departments (2014) or probation offices (2014), the SIPS trials in England seemed to justify commissioning only the most basic, unsophisticated ‘advice’. On average doing more gained nothing and raised costs and implementation barriers. Implications in bite’s Issues section.

K US national programme achieves unprecedented quantity; quality and impact uncertain (2006). Processes and results of the implementation strategy of the US health service for ex-military personnel – in numbers, one of the most successful to date. However, drinking reductions were minor (2010) or absent (2010 2014) and screening missed most (2011) risky-drinking patients.

K Dutch programme fails to engage primary care and may have been counterproductive (2012). Just 3% of practices invited to join the study did, half offered training did not complete even a minimal programme, and the result was that patients were slightly less likely (2012) to remit to non-risky drinking. Engagement levels “reflect the effects of such a programme when conducted in a naturalistic setting” and training and support “did, in fact, increase the odds that patients would continue with hazardous or harmful drinking.”

K Lives cost-effectively improved in England and health costs reduced (2013). Simulation estimated substantial health service cost savings and low-cost health benefits from GP-based alcohol screening and brief advice, but the key assumptions derived from studies divorced from how interventions would routinely be implemented. Review of similar studies below.

R Unclear whether health improvements justify screening and intervention costs (2014). Simulations estimate that these programmes are cost-effective health improvers, but evaluations which actually measured health gains “do not allow any firm conclusions to be drawn”. UK study above.

R ‘As cost-effective as flu jabs’ (2008). In the US context, estimated that screening for risky drinking followed by brief advice was among the most cost-effective preventive services GPs could offer, ranking alongside screening for high blood pressure or immunisation against influenza. Results were highly dependent on the assumptions fed in to the simulation.

R Strategies to implement alcohol screening and brief intervention in primary care (2011). Includes the economic, political, and social environment surrounding and influencing the organisation undertaking the implementation.

R Real-world implementation in primary care (2010). International case studies of system-wide implementation from England, Spain and New Zealand. Pragmatic flexibility in response to the local context was the theme.

G In guidance on both alcohol problem prevention (NICE, 2010) and treatment (NICE, 2011), the UK’s official health advisory body stresses that evidence-based alcohol screening and brief intervention must be resourced as integral parts of health and social care practice. Featured in bite’s Where should I start? and Issues sections.

G Scottish guidance on embedding into routine practice (Scottish Government, 2015). Instructs local health and social care commissioning and planning bodies to plan for routine alcohol screening and brief intervention and stipulates what this should mean in practice. More on practice models and required staff competencies in ‘competency framework’ (NHS Health Scotland, 2010). Discussion on quality criteria in bite’s Issues section.

G ‘Toolkit’ for commissioning alcohol identification and brief advice (2016). From south London’s Health Innovation Network, an online resource bringing together the evidence base and guidance for alcohol screening and brief intervention plus tips for commissioning across a range of settings, a framework for incorporating quality in the commissioning process, and case studies.

G Guides from the charity Alcohol Concern supported among others by Public Health England for community health settings (2015) such as primary care, pharmacy, midwifery, health visiting, drug services, and sexual and mental health services, hospitals (2015) including emergency departments, and criminal justice services (2015). Will help commissioners set expectations and standards for the services they commission.

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