Ross McCormick

Screening for alcohol misuse in elderly primary care patients: a systematic literature review

BACKGROUND Alcohol problems in the elderly are common and frequently undetected, and therefore a potential target for a screening program. METHOD Using Medline, Psychinfo and reference lists from relevant publications, articles were identified testing pen-and-paper screens in the primary care population aged over 60 years. RESULTS Using standard definitions of alcohol problems, conventional screens adapted for use in the elderly have performances similar to screens in the younger primary care population. However, it can be argued that special screens perform better for the elderly. CONCLUSIONS The Alcohol Use Disorders Identification Test is a useful screen for detecting harmful and hazardous drinking in the elderly while the CAGE is valuable when screening for dependence. In the future, the Alcohol-Related Problems Survey, a computer-based screen, may prove to be superior if practical implementation problems can be overcome.

The General Practitioner-Pharmacist Collaboration (GPPC) study: a randomised controlled trial of clinical medication reviews in community pharmacy.

Objectives  There are conflicting results in studies of pharmacists undertaking medication reviews for older people. With increasing promotion and funding for ‘medication reviews’ there is a need for them to be standardised, and to determine their effectiveness and the feasibility of providing them from a community pharmacy. The objective was to determine whether involvement of community pharmacists undertaking clinical medication reviews, working with general practitioners, improved medicine‐related therapeutic outcomes for patients.

General Practitioners, Prevention and Alcohol - A powerful cocktail? Facilitators and inhibitors of practising preventive medicine in general and early intervention for alcohol in particular: A 12-nation key informant and general practitioner study

This study reports a qualitative investigation of the views of key informants (KIs) and general practitioners (GPs) on the nature and extent of preventive medicine and early alcohol intervention in general practice and the current barriers and potential facilitating factors that influence practice. Sixty-seven KIs and 126 GPs were interviewed in 12 countries. There was strong personal and professional support for GP-delivered preventive medicine in general and early intervention for alcohol problems in particular. Opinions differed on whether national health policies encouraged or discouraged GPs to do more preventive medicine. The two key areas identified for prevention were smoking and alcohol, although all but two countries thought that alcohol was the most difficult area for GPs to discuss with patients. KIs and GPs identified similar barriers and facilitating factors. The main barriers were time constraints, lack of financial reimbursement or incentives and insufficient training and education. The ma...This study reports a qualitative investigation of the views of key informants (KIs) and general practitioners (GPs) on the nature and extent of preventive medicine and early alcohol intervention in general practice and the current barriers and potential facilitating factors that influence practice. Sixty-seven KIs and 126 GPs were interviewed in 12 countries. There was strong personal and professional support for GP-delivered preventive medicine in general and early intervention for alcohol problems in particular. Opinions differed on whether national health policies encouraged or discouraged GPs to do more preventive medicine. The two key areas identified for prevention were smoking and alcohol, although all but two countries thought that alcohol was the most difficult area for GPs to discuss with patients. KIs and GPs identified similar barriers and facilitating factors. The main barriers were time constraints, lack of financial reimbursement or incentives and insufficient training and education. The main facilitating factors were more societal concern about alcohol, proactive patients, more time, financial reimbursement and supportive government policy.

The research translation problem: alcohol screening and brief intervention in primary care - real world evidence supports theory.

Translational research projects based in England, New Zealand and Catalonia are described. In combination they provide real world evidence in support of the evolving discourse on translating the evidence on screening and brief intervention for problem use of alcohol so that it is acceptable and fit for routine practice. Acceptance and uptake was enhanced by encouraging primary health clinicians to use evidence-based screening and brief intervention processes which fit with the context in which they work and which build on the skills they already have and use in practice. Emerging general principles included: tailoring procedures to fit with local circumstances; breaking the process down into clinically acceptable steps and negotiating where there is flexibility. Key issues explored in each case study included how ‘screening’ is best conducted, what is a brief intervention best suited to which provider and which providers should run the process.

Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.

INTRODUCTION AND AIMS To estimate the prevalence of risky drinking among customers in community pharmacies and to explore customer attitudes towards screening and brief intervention (SBI). DESIGN AND METHODS Cross-sectional, anonymous survey, using random selection of community pharmacies in New Zealand to collect data using self-completion questionnaires and an opportunity to enter a prize draw. Participants were customers/patients attending the community pharmacy on a specific, randomly selected day (Monday to Friday) in one set week. Alcohol Use Disorder Identification Test (AUDIT)-C using a cut-off score of 5 was used to measure risky drinking. Attitudes towards pharmacists engaging in SBI for risky drinkers were measured. RESULTS 2384 completed customer/patient questionnaires from 43 participating pharmacies. Almost 84% ever drank alcohol and using a score of 5 or more as a cut-off, 30% of the sample would be considered as risky drinkers. Attitudes were generally positive to pharmacists undertaking SBI. Logistic regression with AUDIT-C positive or negative as the dependent variable found those taking medicines for mental health and liver disease being more likely to score negative on the AUDIT-C, and smokers and those purchasing hangover cures were more likely than average to have a positive AUDIT-C screen. DISCUSSION AND CONCLUSIONS This study indicates there is scope for community pharmacists to undertake SBI for risky drinking, and that customers find this to be acceptable. Targeted screening may well be useful, in particular for smokers. Further research is required to explore the effectiveness of SBI for risky drinkers in this setting.

New Zealand community pharmacist attitudes toward opioid-dependent clients

Aim: To survey New Zealand community pharmacists to explore levels of training, attitudes towards providing services for drug users, and associations with current and past practice. Methods: Postal survey of 898 randomly selected community pharmacists. Questions included demography, training and a 20-question attitude scale. Principle component analysis was conducted to identify the main attitude factors. Multiple linear regressions were used to model the effect of different independent variables on the factors. Findings: Twenty-six percent of respondents had previously undertaken training about the management of opioid misuse. Four principal factors explained 57% of the variance within the attitude questions. These were attitudes towards: ‘the general results of dispensing methadone to opioid misusers’; ‘the effect of opioid-dependent clients on a pharmacy’; ‘reducing harm associated with drug use’; and ‘engaging with drug users’. Training (having it or wanting to have it) was positively associated with the four attitude factors. Conclusions: The results of this study indicate that attitudes towards various aspects of service provision to drug misusers may not be as simple as previously perceived.

Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol

Background: Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking. Objective: This feasibility study aims to recruit drinkers between 18–34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions. Methods/Design: Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages. Discussion: Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking. Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921

Estimating problem drinking among community pharmacy customers: what did pharmacists think of the method?

Objectives  Community pharmacists have successfully been involved in brief interventions in many areas of health, and also provide services to substance misusers. There has been recent interest in community pharmacists providing screening and brief interventions (SBI) to problem drinkers. The aim of this study was to develop a method for measuring prevalence of risky drinking among community pharmacy customers and to explore acceptability of this method to participating pharmacists.