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Changing Scotland's relationship with alcohol: a discussion paper on our strategic approach




The service:

In 2005, as part of a 4-tier integrated model of alcohol service, a local enhanced service was successfully piloted that screened and delivered brief interventions for alcohol problems in primary care. Adopting both a targeted ( e.g. all new patients) and opportunistic ( e.g. when misuse clinically suspected) approach, a 1 minute screening questionnaire ( FAST test) - which can identify alcohol misuse through a single question - was used to identify those who were drinking at hazardous and harmful levels. A brief intervention was then carried out, which included useful advice and resources for the patient, such as a drinks diary, estimation of their weekly consumption in units, and a blood sample to evaluate liver function. GP practices received funding when a FAST positive patient who accepted the brief intervention completed a 3 month follow up of their weekly alcohol consumption and liver function.

The outcomes:

Of 543 patients screened, 94 (17%) tested positive for hazardous or harmful drinking. 54 of these showed impaired liver function through the blood test. Of the 93 who accepted a brief intervention, 56 were followed up 3 months later. 33 of the 56 reported reduced alcohol consumption, and liver function had improved in 25. Follow up questionnaires to those who screened both positive and negative for alcohol misuse revealed that between 80% and 90% of respondents were satisfied with the information supplied and were happy to have been asked about their alcohol consumption. 90% said they would be happy to be asked again in future. Plans are in place to roll out the service more widely.


The service:

In 2005, a service was established to tackle alcohol problems identified within their Emergency Department ( ED). Patients identified as having an alcohol related problem are offered a consultation with the alcohol liaison nurse. Depending on their immediate state of health, level of intoxication and time of presentation, this may be immediate or through an appointment for the Alcohol Awareness Clinic. A letter is sent to their home and to their GP to make them aware of the referral. Those who choose not to attend are provided with an information pack tailored to their needs. The clinic is held in a general clinic area to minimise stigmatisation and encourage attendance.

Patients receive a half hour appointment to discuss their alcohol issue. Motivational interviewing and support is offered, and follow-up treatment paths, where necessary, are explored, including through referral to detoxification services or signposting to services in the community. GPs and A & E consultants are made aware of the outcome. In addition, the alcohol liaison service provides a support service to inpatient areas and delivers alcohol awareness training to staff across the hospital campus.

The outcomes:

The alcohol awareness clinic has achieved a 50% attendance rate in a population known to be difficult to encourage into services. Six month follow up is being undertaken to establish the level of success achieved by the brief intervention service. The pilot has extended to Ayr hospital inpatient wards, with a half-day alcohol awareness clinic in Ayr A&E in operation from April 2008.