SIPS Research

The controlled trials into screening and interventions for sensible drinking are taking place in the three following areas:

View these for an overview of the research and links to the Controlled Trials Register.

• Primary care
• Accident and Emergency
• Criminal Justice

The Primary Health Care (PHC) study

• Primary Care controlled trials register

This uses a pragmatic nested factorial design including a cluster randomised element to evaluate the implementation, effectiveness and cost effectiveness of different models of alcohol screening and brief intervention piloted in 24 typical primary health care practices in three English regions.

The study will test three models of implementation: a control group receiving a patient information leaflet (PIL), brief advice provided by PHC staff plus PIL, and brief lifestyle counselling provided by PHC staff plus PIL. Two screening approaches (targeted vs universal) and two screening tools of different complexity will be compared. 744 hazardous or harmful drinking patients will be recruited for the study (31 per PHC). PHC study outcomes will include measures of implementation, attitudinal and organisational predictors of implementation, and patient outcomes, which will include drinking behaviour, alcohol related problems, quality of life and health economic outcomes. The PHC study is designed to answer key policy questions concerning the implementation of screening and brief intervention in PHC

The Accident and Emergency Department (AED)

• Accident and Emergency Department controlled trials register

This study also employs a cluster randomised and nested factorial design to test the impact and cost effectiveness of implementing three models of screening and brief intervention piloted in 9 AEDs in the same 3 regions as the PHC study. The study will compare three conditions: a control group receiving a patient information leaflet (PIL); AED staff trained to provide brief advice with hazardous and harmful drinkers attending AED plus PIL; and AED staff trained to screen and refer to an alcohol health worker who will carry out brief lifestyle counselling plus PIL.

The AED study will also compare targeted and universal screening approaches. However, due to the limited number of AEDs in the North East and the anticipated difficulties in finding 18 sites needed to have the same design as in the PHC study, a slightly different study design has been planned. Six AEDs across the 3 regions will be randomly allocated to universally screen, collect information about whether a patient would be part of a linked (targeted) presentation group and subsequently use statistical simulations to analyse the interactions and devise the optimal targeted screening strategy using these tools.

Three further AEDs will be randomly allocated to carry out targeted screening using the Paddington Alcohol Test (PAT) which is the purpose and method the PAT was designed for. Thus we will be able to compare the efficacy of targeted and universal screening. 1179 subjects will be recruited (131 per AED). Study outcome measures will be the same as in the PHC study yielding important information on the effectiveness and cost effectiveness of different implementation approaches to guide implementation in AEDs nationally.

The Criminal Justice Study (CJS)

• Criminal Justice Study controlled trials register

This will compare the relative effectiveness of two screening tools and three forms of intervention of different intensity and duration. Overall 96 Offender Managers from 9 probation offices across 3 English regions (London and the South East Regions (n=5), North East Region (n=4)) will be recruited. In London and the South East Regions it is likely that the five offices will be situated in the London boroughs of Brent, Enfield, Lambeth and Southwark and in Winchester.

Within each office approximately 10-11 Offender Managers will each need to recruit five offenders to the study during a nine month period. In the North East it is likely that the four offices will be situated in Darlington/Durham, Newcastle, Northumberland and South of the Tyne.

Within each office approximately 10-11 Offender Managers will each need to recruit five offenders to the study during a nine month period. Offender Managers will be fully trained during a 2-3 hour training session by the research team and the experienced Alcohol Health Workers and will also receive ongoing support during the time of the project. The 96 Offender Managers will be randomly allocated to screen for alcohol use disorders on their caseload using a short screening questionnaire (either the Fast Alcohol Screening Test (FAST) or the Modified Single Alcohol Screening Question (M-SASQ) and to deliver one of three intervention conditions:

1. A client information leaflet control condition (n=32 Offender Managers)
2. 5 minute simple structured advice (n=32)
3. 20 minute brief lifestyle counselling delivered by an Alcohol Health Worker (n=32).

When a client screens positive, the OM will invite them to participate in the research and ask them to complete a short questionnaire before they receive the intervention. They will receive a £10 voucher for taking part in the research. All offenders will then be contacted via telephone by research staff in 6 months time, who will administer the same questionnaire. They will receive another £10 for doing this. Overall the 6 month follow up will provide important information on the effectiveness and cost effectiveness of screening and brief intervention for alcohol use disorders in probation. We will also look at OMs and clients views about the appropriateness and acceptability screening and intervention, and examine the staff and organisational factors associated with successful implementation.

All the programme elements together will lead to the following outputs: 6 monthly interim reports describing progress and early lessons learned from the pilots; a final report to the Department of Health with an accessible summary for a wide audience in the field; a toolkit of validated screening and brief intervention packages appropriate to various settings and protocols for their use. Subject to agreement with the Department of Health we aim to publish the findings in academic journals and present the findings at local, national and international meetings.

The programme will be managed by a principal investigator and a project management group, and will establish a steering group of key stakeholders to advise and support the development of the trials. Each programme element will have staff dedicated to its implementation and with key individuals responsible for coordination of the overall programme and each element to ensure successful delivery. The whole programme will take place over 2 years and will be the largest alcohol screening and brief intervention pilot study so far conducted in the UK. The programme will address key gaps in the current evidence base on screening and brief intervention and should provide invaluable information to guide further development and implementation of the National Alcohol Harm Reduction Strategy in England.