Ranjita Dhital

Community pharmacy-based alcohol brief intervention in the UK: significant alcohol consumption reduction in risky drinkers

Previous studies have shown that community-pharmacy– based screening and brief intervention (SBI) for risky alcohol use is feasible. However, few studies have reported significant reductions in alcohol use following pharmacy-delivered BI. In this study, trained pharmacists (N = 29) at 28 community pharmacies in London, UK, offered BI from February-July 2010. Customers seeking alcohol-related medication and/or advice were targeted. Participating pharmacists used Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores (≥3 for women and ≥4 for men), a seven-day drinking diary, and feedback on a readiness to change form to identify people with risky drinking and to inform appropriate advice and feedback. One in four community pharmacy customers (n = 246) offered the alcohol BI were initially interested, and half of these (n = 134, 87 of whom were men) received the intervention. Of the 128 customers whose alcohol use was recorded, 16% (n = 21) were classified as high-risk drinkers, 56% (n = 72) as increasingrisk drinkers, and 27% (n = 35) as low-risk drinkers. Three months following BI, low- and increasing-risk drinkers were contacted by a member of the study team to obtain a post-BI AUDIT-C score and to assess past seven-day alcohol consumption. High-risk drinkers were contacted to ascertain whether they had accessed specialty alcohol services. Seventy-five customers were available for follow-up (response rate, 56%). Of the high-risk drinkers, 91% (n = 10) had seen their general practitioner (GP) and/or accessed specialty alcohol services. Increasing-risk drinkers were found to have significantly reduced their weekly consumption (average decrease, 84%; p = 0.004) and number of drinking days (p = 0.05), however, no significant change in AUDIT-C score was observed. As anticipated, no significant differences in consumption were observed for low-risk drinkers. In this study, community-pharmacy–based alcohol SBI was effective in reducing weekly alcohol use among increasing-risk drinkers and facilitated contact between high-risk drinkers and their GPs and/or specialty alcohol treatment services.

Alcohol brief intervention delivered in UK community pharmacies: customers’ experiences

Pharmacy-based alcohol brief intervention (BI) has the potential to identify risky drinkers in the general population, but the opinions of users regarding the service remain relatively unexplored. Alcohol BI was offered to customers by trained pharmacists (n = 29) at 28 London, UK, community pharmacies between February and July 2010. Customers requiring alcohol-use related medication and/or advice were targeted. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), a drinking diary, and a readiness to change assessment were used by pharmacists to assess and provide appropriate feedback regarding alcohol use. Customers also received written information, including a UK Department of Health “Units and You” booklet. Following BI, customers were given a confidential service evaluation questionnaire to complete and return to the project team using a prepaid envelope. This invited responses to closed- and open-format questions regarding their initial reason for visiting the pharmacy, why they took up the BI service, and their levels of satisfaction with the service delivery and environment. Of the 134 customers who received a BI, 58% (n = 78) returned the questionnaire. Bringing a prescription for dispensing was the most common reason for the pharmacy visit (55%, n = 43). Wishing to find out about alcohol use and concerns for personal health were the two most reported reasons for taking up the service. Almost one-quarter of customers (n = 18) reported that they liked having increased their alcohol-related awareness, and 18% (n = 14) indicated that they liked the informative written information. The privacy (74%, n = 57), confidentiality (77%, n = 59), and quietness (70%, n = 54) of consulting rooms was rated as good, with 77% (n = 60) of customers reporting they would recommend this service to others. In line with past primary care BI studies, customers were generally positive about the experience of receiving BI in community pharmacies and would recommend it to others.

Effectiveness of alcohol brief intervention delivered by community pharmacists: two-arm randomised controlled trial

The UK Department of Health’s aim is to involve community pharmacists in the delivery of alcohol brief intervention (BI). This possibility extends the settings in which BIs have been delivered and has attracted international attention. The objective of this study was to assess the effectiveness of BI delivered by community pharmacists in a randomised controlled trial (RCT) in London. A two-arm RCT was conducted to determine the effectiveness of BI delivered by community pharmacists. Pharmacists and their support staff were trained in the trial procedures. Pharmacy support staff (N = 23) approached and informed customers about the study, to support formal recruitment by the community pharmacist (N = 17). Eligible and consenting pharmacy customers (aged≥18 years) at the 16 community pharmacies were randomised in equal numbers to either BI delivered by a community pharmacist or a non-intervention control condition, conducted in the pharmacy consultation room. The intervention was a brief motivational discussion of approximately 10 minutes duration. Participants randomised to the control arm were given an alcohol information leaflet with no opportunity for discussion. At 3-month follow up, alcohol consumption and related problems were assessed with the Alcohol Use Disorders Identification Test (AUDIT) administered by telephone. Of the 1440 customers approached, 541 (38%) consented to participate. Of those who consented, 409 were identified as hazardous/harmful drinkers (AUDIT 8-19), 94 as low risk drinkers (AUDIT≤7), and 38 as possibly dependent drinkers (AUDIT≥20), with the latter two groups excluded from the trial. The 409 trial participants were followed up at three months (follow-up rate ≥80%). Data analysis is under way and the preliminary main trial results are presented here. This is the first presentation of trial outcomes from this internationally significant study.

The development of pharmacy brief intervention practice: overview of a research program

Brief intervention (BI) delivered in pharmacies is not currently routine practice, nor is there evidence regarding its efficacy. Community pharmacies attract a large and diverse range of people to a health-care environment that is promising for BI research. Work undertaken by this research group included semi-structured interviews with pharmacy service users to obtain their views on potential pharmacy BI; a five-month cohort study with 134 participants conducted in 28 pharmacies that assessed feasibility issues; and focus-group studies with “active” and “less active” pharmacists to identify barriers and facilitators of implementing BI. Pharmacy service users were positive about participating in BI, which was found to be feasible. Training and staff support were identified as important factors influencing service delivery, and there are preliminary indications of effectiveness including an impressive reduction in overall consumption among those who completed follow-up. Pharmacist motivation has been evaluated with the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), and role adequacy and work satisfaction improved among “active” pharmacists. These outcomes are currently being used to inform the development of a randomized controlled trial of BI delivered in the pharmacy, due to begin soon. It is hoped that findings from the trial will contribute to current knowledge and promote interest in the area. Unanswered questions include how pharmacy BI can be implemented in routine practice if trial results demonstrate effectiveness, and how SBI fits with the needs of a changing pharmacy profession.