1. Identification and Brief Advice: A recommended approach for older people Presentation to alcohol and older people conference 19 March 2010, Taunton George Ames george@forster.co.ukgeorge@forster.co.uk

2. This presentation Why IBA? Summary of research into barriers and motivators to delivering IBA Where to go to order materials and find out about the new national alcohol campaign, Alcohol Effects

3. Why IBA? Advertising and traditional comms routes don’t tend to resonate amongst those aged 55 and over Behaviour is entrenched There is a feeling amongst many that they are the ‘good guys’: not dependent drinkers and not binge drinking In their mind, they’re in control of their drinking – they don’t binge drink, they’re not alcoholics and they believe they know their individual limits

4. Why IBA? Healthcare professionals, particularly GPs, are trusted Many will be visiting their GPs frequently about conditions e.g. high blood pressure, diabetes etc The personal face to face identification of risk level, backed with provision of take away information is favoured

5. Research for national campaign showed… Idea of alcohol exacerbating existing conditions is largely new news This news ignites behaviour reconsideration particularly for the over 55s, who were less likely to change their behaviour in response to the main campaign messages Role for multiple health harm messages but focus on key harms (stroke, localised cancer, heart disease) will have most impact A good fit with IBA and NHS setting

6. Context IBAs must be seen in context: –70,000 more alcohol-related admissions each year [1] –7.6m higher risk drinkers [2] –2.9m show harm, 1.1m addiction [2] –Direct cost: £2.7bn [3] IBAs work: –Reduces consumption by 20% in higher risk drinkers –Reduces consumption in 1 in 8 lower risk drinkers [1]Alcohol Learning Centre [2] Department of Health. The cost of alcohol harm to the NHS in England: An update to the Cabinet Office (2003) study. 2008 [3] National Audit Office. Reducing Alcohol Harm: Health services in England for alcohol misuse. Report by the comptroller and Auditor General. London: The Stationery Office, 2008. HC 1049 Session 2007-2008

7. Recognised challenges However there are a number of recognised challenges to IBAs: –Varied levels of awareness –Inconsistent use –Lack of data on use –Units are not always understood by stakeholders or public –IBAs competing for professionals’ attention against many other initiatives –No magic bullet - IBAs are just one element of an overall strategy to reduce alcohol related harm

8. Research methodology, results and conclusions

9. Research overview Our first stage has been secondary research –Collating existing material and literature –Conducting interviews with stakeholders (x 22) –Consulting with regional alcohol managers (RAMs) Our second stage was informed by the first –Primary research with target audience groups GPs, nurses, A&E staff x 6 focus groups with professionals selected because they do/do not know about and use IBA

10. Research conclusions 1) Understanding and awareness of IBA The term IBA is not well understood and may be inconsistently described It is seen as a diagnostic to identify dependent drinkers rather than an intervention, compounding concerns about resources/unmet need Its connection to FAST/AUDIT is not always recognised 2) Personal and professional Professionals question the need to target increasing and higher risk drinkers Staff are concerned about validity of Units measure The negative experiences of A&E staff makes it difficult to empathise with patients admitted in these circumstances

11. Research conclusions/2 3) Prioritisation Workload is an issue for all NHS staff Perceiving it as a diagnostic rather than an intervention makes it less immediately urgent/useful 4) Unmet need Concerns about unmet need fall into two categories –Immediate capacity to offer support –System wide capacity, particularly for dependent drinkers The perception that the IBA necessitates onwards referral perpetuates this A perception also exists, particularly for A&E staff, that IBAs can open a can of worms

12. Research conclusions/3 5) Joined up working Alcohol is seen as being part of a much bigger picture – cross- sector team work required Chronic diseases are thought to provide a context in which to discuss alcohol A range of different groups are delivering IBAs –A&E staff operating in a significantly different environment to GPs 6) Practical concerns There are potential emotional barriers that require significant emotional/psychological dexterity – very personal questions Actual completion of the questionnaire can be difficult –Professionals question whether it would be best done as self- assessment/online

13. Research conclusions/4 7) Practical experience vs theoretical direction Professionals can use two key routes for decision making –Their own experience –Guidelines from the centre Unless they perceive the guidance as useful or mandatory, they won’t use it

14. Barriers and Exchange

15. Barriers to IBAs Summary: Perceived Barriers to using IBAs Time –Generally short consultation times –Already many things to do – lack of staff resources Lack of confidence in the tools / measures –Language, questions –Levels – scores –Influenced by their own drinking What next? –Lack of skill in providing advice –Lack of knowledge about referral routes Patient motivation –Disclosure of accurate consumption rates –Not really wanting to change –Fear of being labelled DH IBA Alcohol Stakeholder Research

16. Benefits of IBAs Summary: Perceived Benefits of using IBAs DH IBA Alcohol Stakeholder Research Good for identifying people for referral –Considered to help identify patients who need intervention – but concern about next steps Provides a mechanism for discussion about alcohol –Helps raise a difficult issue –Raises awareness in general Consistency of assessment –Positive about consistent measurement –Confusion about different IBA methodologies Enables continuity of care –Potential tracking to follow-up patients

17. Barriers and exchange GPs 17 BarrierExchange Query credibility of the levels (scores) provided by IBAs Show that IBAs work, are worthwhile and that scores are meaningful – case studies and evidence Query reliability of data given by patient – not perceived to be an accurate assessment Show evidence of IBA data being used in a constructive manner – results driven Language problems – questions too formal – would need translation Provide guidance on language used with patients Fear of permanency – labelling patient Provide guidance on language used with patients – and increase awareness of follow up/referral routes for dependent patients Not enough timeConsider development of self- assessment tool Incentivise to increase priority

18. Barriers and exchange Nurses 18DH IBA Alcohol Stakeholder Research BarrierExchange Not enough timeSimplify the tools to save time Develop self-assessment tool Can be seen as just another paper exercise – ticking boxes Show it is worthwhile – results driven. Consider incentivising Not always appropriate – often better to take informal approach with patients Provide guidance on language used with patients Sets up expectations of doing something about it – don’t have the training Online training using eLearning module. Increase ease of referral and expert follow up if required

19. Barriers and exchange A&E staff 19DH IBA Alcohol Stakeholder Research BarrierExchange Not enough timeUse a simplified tool to save time Consider incentivising Patients often too drunk to do assessment – difficult to get realistic data Deliver IBA as part of A&E discharge process. IBA is not designed to be done whilst people are drunk Who would do it? Not enough staff Provide adequate training: A&E eLearning pathway being developed

20. Live activity and next steps

21. National activity Development of microsite with Doctors.net targeting GPs Additional eLearning workshops for nurses Trade and stakeholder comms to help tackle some of the barriers Regional presentations to share the findings Developing factsheets and sharing comms tools with RAMs

22. What can be done locally to support? Consider how the barriers/motivators can be addressed locally What networks, comms channels and meetings can be used to help tackle some of the misunderstandings about IBA Encourage people to visit www.alcohollearningcentre.org.uk to take eLearning module (supported by RCN, RCP and RCGP) and order resourceswww.alcohollearningcentre.org.uk Piggyback on live national Alcohol Effects campaign: encourage IBA delivery whilst people are being reminded of the harm alcohol can do: same audience, Increasing and Higher risk drinkers

23. Ordering materials and linking with national campaign All material, such as GP Factsheets can be downloaded/ordered from the Alcohol Effects area of the Alcohol Learning Centre –www.alcohollearningcentre.org.uk/alcoholeffectswww.alcohollearningcentre.org.uk/alcoholeffects Materials tailored to specific conditions, aimed at over 55s –Stroke leaflet and blood pressure leaflet Consumer site: www.nhs.uk/drinkingwww.nhs.uk/drinking Support with social marketing activity: socialmarketing@alcohollearningcentre.org.uk socialmarketing@alcohollearningcentre.org.uk

24. george@forster.co.uk www.alcohollearningcentre.org.uk www.nhs.uk/drinking