Alcohol Aware Practice Rolande Anderson, Project Director, “Helping Patients with Alcohol Problems”, Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2 Supported by Merck Pharmaceuticals. A Joint ICGP/Department of Health Initiative EU Study – Barcelona, February, 2003

Statistics 12.3 litres of pure alcohol per capita (2000) 2 nd Beer consumption in world. Alcoholic drinks market worth €6.81 billion Approx. ¼ drinking above “safe” limits. Irish people –47% + on alcoholic drinks 2000 v 1996 –Why? ? ‘Celtic Tiger’ ? Availability ? Marketting Mater Hospital study –In-patients Alcohol Abuse or Dependence 30% Male 8% Female ESPAD Study –Ireland top of the league for binge drinking among females

Alcohol Aware Practice Pilot Study Aims To develop, at a General Practice level, programmes of concerted action involving all practice staff, in order to prevent, detect and treat patient problems associated with alcohol.

Screening Methods Urine Tests Blood Tests Breathalyser Clinical Examination Asking Questionnaires –CAGE –Brief Mast –AUDIT –AUDIT C –Five Shot

We do this by…… Increasing staff awareness and expertise. Improving individual patient records of alcohol consumption. Developing an education / information plan. Training doctors to intervene effectively during every consultation. Training Practice Nurses. Maintaining intervention records.

We do this by…… Establishing practice policy on referral for more intensive care. Developing practice advocacy for such services where they are currently inadequate Appropriate use of screening instruments. Categorising all patients as ‘Non-Drinkers’, ‘Low risk’, ‘Hazardous’, ‘Harmful’ and ‘Dependent’ drinkers. Developing management guidelines appropriate to each category.

Methods Questionnaire –A.U.D.I.T. 1:5 patients 1:9 –CAGERANDOM Blood Tests –LFT’s –MCV Allocation of Patients –Low risk –Hazardous drinking –Harmful –Dependent Brief Intervention Exclusion criteria Training – key practice staff Follow-up Referral Materials

Health Board Areas of Ireland

The Area Covered by the ERHA

AAP Pilot Study Participating Practices

Results The results will look at the training programme and the three main areas of the study – screening, detection, treatment and referral. Weekly consumption of standard drinks will be recorded at the initial interview and again at a 3 month follow-up interview. Numbers screened and the percentage of those screened who fit into the ‘diagnostic categories’ ie. low risk, hazardous etc Figures will be broken down for each region with age and sex profiles. Action taken in terms of treatment and referral will also form part of the results. The practice staff will also be asked to evaluate the training programme, materials and pilot study.

AAP Recording Form

Evaluation Comfort levels before and after on SCALES of 0-10: –Dealing with alcohol problems –Knowledge of withdrawal –Awareness of referral services –Knowledge of “safe”/weekly consumption levels –Ability to use questionnaires –Knowledge of brief intervention –Confidence in Dealing with Alcohol Problems Other Comments

Most Significant Advances ICGP Project “Helping Patients with Alcohol Problems” March 2000-February National Conference – “Alcohol and Young People”, October Alcohol Aware Practice Pilot Study (six months) commenced 4 September 2002

Barriers Funding GP Attitudes GP Confidence

Key Advances Expanded AAP Study Central Government Funding Training for GPs and Practice Nurses More committed personnel Special Type Consultation Fees

To make changes possible Belief that it is worthwhile amongst GPs Shifts in attitudes –GPs –Governmental –Health Boards Funding increases