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Study set in Canada and the United States finds more than enough financial justification for expanding prevention of foetal alcohol spectrum disorders. But what does ‘expansion’ mean – universal prevention, or focusing resources on those most at risk?
MATRIX CELL 2020 HTM file
Alcohol Treatment Matrix cell E2: Treatment systems; Generic and cross-cutting issues
Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing treatment. Explores whether payment by results stifles patient-centred practice or stretches services beyond comfort zones, the surprising results of a randomised trial of service-improvement mechanisms, and the multiple answers to how many drinkers should be in treatment. See the remaining four cells in row 2 of the matrix for more on generic features of medical and psychosocial therapies.
A flagship drug treatment policy initiative appears to have backfired in England, where the government’s pilot payment-by-results schemes seem to have led to fewer successful completions of treatment and more prospective patients declining treatment.
MATRIX CELL 2019 HTM file
Alcohol Treatment Matrix cell E1: Treatment systems; Screening and brief intervention
Key studies and reviews on local, regional and national systems for implementing alcohol screening and brief intervention. Context is that Britain’s National Institute for Health and Care Excellence insists commissioners and managers “must” provides the resources needed for brief intervention to become part of everyday work. Can these interventions be widely implemented, and even if they are, will they improve public health? See the rest of row 1 of the matrix for more on screening and brief interventions.
STUDY 2019 HTM file
Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time-series analysis
The clearest impact of financial incentives to screen primary care patients in England was the plummeting screening rate after the incentives were withdrawn. If these results are applicable to England as a whole, over the following 21 months withdrawing the payments resulted in 603,719 fewer patients being screened for risky drinking and 27,439 fewer receiving brief advice.
Did minimum unit pricing have an immediate impact in Scotland, and did any evidence emerge to support fears that the policy would unfairly target moderate drinkers, particularly in lower income groups?
Simulation study calculated health care cost savings and benefits for patients in England which make routine GP-based screening and brief advice for excessive drinking look an unmissable bargain, but the key assumptions derived from studies divorced from how interventions would routinely be implemented.
In these UK national prevention guidelines, experts prioritised population-wide changes like price rises and outlet restrictions which affect everyone, independent of the choices they make. But in England government prefers to target what they see as the troublesome minority, not the responsible majority.
HOT TOPIC 2018 HTM file
Measuring alcohol-related harm; politics and science
One of our selection of hot topics – important issues which sometimes generate heated debate. At a national level, alcohol-related harm and especially the net cost of harm versus benefits are slippery concepts. Malleability and policy salience combine to make the estimates contested territory.
Taking a public health and human rights-based approach, the 2018 strategy from Scotland strives to improve citizens’ lives by preventing and reducing the harms of drinking and drug use.
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