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Introduction to SIPS

Introduction to SIPS. Professor Colin Drummond Institute of Psychiatry King’s College London. Topics. What do we already know about screening and brief interventions? What research questions will SIPS address? What is SIPS and how did it come about?

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Introduction to SIPS

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  1. Introduction to SIPS Professor Colin Drummond Institute of Psychiatry King’s College London

  2. Topics • What do we already know about screening and brief interventions? • What research questions will SIPS address? • What is SIPS and how did it come about? • What will come out of SIPS over the next year?

  3. What do we already know?

  4. Source: Anderson & Baumberg, 2006

  5. Alcohol: It’s a drug Jim, but not as we know it.

  6. Acute effects Highly variable Pleasure, relaxation Impaired judgement, coordination, balance Mood effects Argumentativeness and aggression Drowsiness Impaired consciousness Coma, respiratory depression and death. Chronic effects Toxic effects on organs Over 60 diseases Psychiatric disorders Foetal alcohol effects Psychoactive effects: alcohol dependence 3rd leading cause of disability after tobacco and hypertension No universally “safe” level Alcohol is a toxic and dependence producing DRUG

  7. Alcohol use disorders: prevalenceDrummond et al., 2005 • 26% of the adult population have an alcohol use disorder (AUD) • Includes 38% of men & 16% of women aged 16-64 • 23% of the adult population are hazardous or harmful alcohol users (7.1 million people in England) • 21% of men and 9% of women engage in binge drinking • Prevalence of alcohol dependence is 3.6% overall, 6% among men, and 2% among women (1.1 million people in England) Alcohol dependence is considerably more prevalent than drug abuse Alcohol Needs Assessment Research Project, 2005

  8. Chronic liver disease and cirrhosis mortality rates per 100,000 population, 1950-2006

  9. National A&E studyDrummond et al., 2003 • Funded by Strategy Unit/Dept of Health • Maximum burden of alcohol on A&E departments • Regional variations • 36 randomly selected A&Es in England (18%) stratified by region and urban/rural • 116 researchers, 25 regional coordinators • All A&E attenders > 18 years between 0900 and 0859hr Saturday/Sunday

  10. National A&E study • Predictors of ETOH+ • Young, white, males, single/divorced, unemployed, living with parents or NFA, frequent attenders (1.6x) • More often brought by police/ambulance • Reasons for attendance • Violent assaults involving weapons, RTA, psychiatric emergency, DSH • Weapons: fists, knives, shoes, glasses • Locations: clubs, pubs, public transport • Correlations with general population data • Fridays and Saturdays: Estimated 1,000,000 alcohol related A&E attendances per annum

  11. Screening and referral to an alcohol health worker in AED (Crawford et al., 2004, Barratt et al., 2005) • Pragmatic RCT comparing leaflet with referral to Alcohol Health Worker • Screening using Paddington Alcohol Test • 599 randomised • AHW group less drinking than leaflet • Fewer AED attendances (mean 0.5) • AHW more cost effective

  12. SBI in primary care • Prevalence ~20-30% • Frequent attenders • Screening & health promotion role • Early detection & intervention • Effect of alcohol intervention on health outcomes • 5-30 min of targeted advice

  13. Evidence-Base for SBI • Freemantle 1993 - 6 trials in primary care • 24% drop in consumption (95% CI 18 to 31%) • Moyer 2002 – 56 trials, 34 relevant to PHC • Consistent positive effect, NNT 8-12 (smoking=20) • Cost savings found at 4 years in the USA • Kaner 2007 – 29 trials in PHC & A&E • Consistent positive effects ~7 drinks less/week • Evidence strongest for men, less work on women • No significant benefit of longer versus shorter BI

  14. What is known already about SBI? • A&E: SBI is effective and cost effective in academic centres (e.g. St Mary’s Model) • Primary Health Care: SBI is effective and some evidence of cost effectiveness across range of international settings • General Hospital: SBI less effective • General lack of research in UK • In all cases SBI effective for opportunistic intervention in non-treatment seeking populations. Less effective for treatment seeking/alcohol dependent patients

  15. What is not known about SBI? • A&E: can it be effectively implemented outside academic centres in UK? • PHC: is it cost effective and can it be implemented in “typical” PHC setting? • CJS: is it feasible to implement SBI, and is it effective? • All settings: • What are the best screening tools (short vs longer) and method (universal vs targeted)? • Is extended BI better than 5 min advice? • What are the barriers/facilitators for implementation in the “typical” setting? • Effectiveness in females, young, BME

  16. Alcohol Screening and Brief Intervention Research ProgrammeSIPS A&E St. Mary’s 'Scientia Vincit Timorem'

  17. Programme design • Funded by Department of Health for 3 years • Jointly led by IOP & Newcastle University • 3 cluster randomised clinical trials of alcohol screening and brief intervention (PHC, AED, CJS) to assess: • What are the barriers/facilitators to implementation in a “typical setting”? • What is the most effective screening method? • What is the most effective and cost effective intervention approach? • Total target of 2,403 subjects, completed 2,600 July 2009 • 6 and 12 months follow up, currently 80% @ 6 months (mainly phone)

  18. King’s College London Prof C Drummond (CI) Dr J Myles PI Dr P Deluca PI Mr T Phillips PI Ms K Perryman PI Dr M Cochrane Ms D Jeffery Dr M Hobbs Ms R Cappello Mr S Keating Ms L James Ms L Rail Ms J Reid Ms R Lee Mr S Gordon Ms L Floodgate Mr D Kerr Mr H Mosaheb Ms C Elzerbi St George’s Dr A Oyefeso PI York Prof S Coulton PI (now Kent Univ) Prof C Godfrey PI Mr S Parrott PI Prof M Bland PI Newcastle Prof E Kaner (DCI) Prof C Day PI Dr E Gilvarry PI Dr P Cassidy PI Dr D Newbury-Birch PI Prof Nick Heather PI Ms K Jackson Ms N Brown Ms M Clifford Ms E Phinn Ms C Shaw Ms R McGovern Ms A Hindhaugh Ms G Hawdon Ms D Carpenter Mr G Scott Ms J Armstrong Ms D MacDonald Imperial College and St Mary’s Hospital Dr M Crawford PI Prof R Touquet PI Alcohol Concern Mr D Shenker PI Primary Care Research Network Mental Health Research Network SIPS Research Project Group

  19. 9 Clusters 1 AED 2/3 PHC 2/3 CJS 1 AED 2/3 PHC 2/3 CJS Newcastle General Darlington Memorial 1 AED 2/3 PHC 2/3 CJS 1 AED 2/3 PHC 2/3 CJS 1 AED 2/3 PHC 2/3 CJS South Tyneside Winchester Hexham 1 AED 2/3 PHC 2/3 CJS 1 AED 2/3 PHC 2/3 CJS 1 AED 2/3 PHC 2/3 CJS 1 AED 2/3 PHC 2/3 CJS King’s College St Thomas’s Central Middlesex North Middlesex

  20. How will we assess effectiveness? • Effectiveness of implementation • Extent of screening and intervention activity • Attitudes to SBI implementation • Patient outcome measures • Alcohol consumption (extended AUDIT-C) • Alcohol related problems • Health related quality of life • Health related and wider societal costs

  21. Website www.sips.kcl.ac.uk

  22. Training and intervention tools

  23. Presentations • Accident and Emergency study: Dr Paolo Deluca • Primary care study: Prof Eileen Kaner • Criminal justice study: Dr Dorothy Newbury-Birch • Early findings on screening: Prof Simon Coulton • Discussant: Dr Peter Anderson

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