IBA - Provide more help to encourage people to drink less

What does this mean?

Identification and Brief Advice (IBA) is opportunistic case finding followed by the delivery of simple alcohol advice (in the research literature, this is referred to as Alcohol Screening and Brief Interventions). These are effective interventions directed at patients drinking at increasing or higher-risk levels who are not typically complaining about or seeking help for an alcohol problem.

IBA can be effectively implemented in a number of settings including:

• Primary Care - targeted at increasing and higher risk groups
• A&E Departments - possibly with the use of Alcohol Liaison Nurses or Alcohol Health Workers
• Specialist settings - e.g. maxillofacial clinics, fracture clinics, sexual health clinics
• Criminal justice settings such as Probation and arrest referral schemes (evidence to support this setting is still emerging)

What is the evidence that this works?

There is a very large body of research evidence supporting IBA in primary care including at least 56 controlled trials (Moyer et al., 2002). A Cochrane Collaboration review (Kaner et al., 2007) provides substantial evidence for the effectiveness of IBA.

For every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels (Moyer et al., 2002). This compares favourably with smoking where only one in twenty will act on the advice given (Silagy & Stead, 2003). This improves to one in ten with nicotine replacement therapy.

Patients who received IBA in A&E made 0.5 fewer visits to the A&E during the following 12 months (Crawford et al., 2004).

References

Crawford, M.J., Patton, R., Touquet, R., Drummond, C., Byford, S., Barrett, B., Reece, B., Brown, A., and Henry, J.A. (2004) Screening and referral for brief intervention of alcohol-misusing patients in an Emergency Department: a pragmatic randomised controlled trial, The Lancet, 364: 1334-1339.

Kaner E, Beyer F, Dickinson H, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Bernand B. Brief interventions for excessive drinkers in primary health care settings. Cochrane Database of Systematic Reviews 2007, Issue 2. Art No.:CD004148 DOI: 10.1002/14651858.CD004148.pub3.

Moyer, A., Finney, J., Swearingen, C. and Vergun, P. (2002) Brief Interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment -seeking and non-treatment seeking populations, Addiction, 97, 279-292.

Silagy, C. and Stead, L.F. (2003) Physician advice for smoking cessation (Cochrane Review), in: The Cochrane Library, Issue 4 (Chichester, Wiley).

Case Examples

Camden PCT

The Camden Local Enhanced Service (LES) is designed to support interventions which are known to be effective in reducing alcohol misuse. The Local Enhanced Service has been implemented in Camden GP Practices with input from the PCT Sensible Drinking Service and other Camden alcohol provider services.

The Camden Alcohol LES has three levels. Practices can choose to participate in only the lower levels or in all of them. Practices applying for the LES are expected to provide both lower levels as a minimum. The LES will be reviewed after the first six months of implementation.

NHS Stoke on Trent

Stoke has set out a framework for quality improvement in general medical practices, as an integral part of their Primary Care Strategy. The ultimate purpose of the initiative is to reduce health inequalities across the population of Stoke on Trent and improve health outcomes. It will incentivise general practice teams to strive for and attain aspirational standards that are set over and above contractual and statutory requirements and the quality and outcomes framework (QOF). The PCT will be providing support and development for practices to achieve exemplary standards of service and high quality care for all55. The process is voluntary seeking continuing quality improvement year on year. The scheme, which covers all aspects of primary care, makes specifi c reference to preventing alcohol-related harm throughout. This ranges from looking at expected prevalence data on joining the scheme through to exemplary standards around identifi cation and brief advice. The document, Improving health outcomes: Setting aspirational standards in general medical practices in Stoke on Trent, can be found at the following address and will be continuously updated as standards rise; http://www.stokepct.nhs.uk/pdfs/890.pdf

The Sheffield Identification and Brief Advice Training Project

This programme is designed to develop skills amongst a range of Tier 1 and 2 staff working face-to face with increasing and higher risk drinkers, and enabling these staff to deliver opportunistic identification and brief advice in their communities.

View the full project on HubCAPP: www.hubcapp.org.uk/QXDT

Hampshire Brief Interventions Training

Since March 2007, Hampshire DAAT has provided alcohol IBA training to over 150 front line staff from a variety of organisations across the statutory and voluntary sector.

View the full project on HubCAPP: www.hubcapp.org.uk/GWQU

Cornwall Brief Interventions Training

In November 2007, Cornwall & Isles of Scilly PCT employed a Brief Intervention Officer to set-up and deliver an IBA training package in the area. The role encompasses the co-ordination of training materials (including a website, leafl ets and training resources) and the delivery and evaluation of training sessions in identifi cation and brief advice to a range of organisations across Cornwall.

View the full project on HubCAPP: www.hubcapp.org.uk/TL73

Gloucestershire Alcohol Arrest Referral Scheme

In 1999, the Gloucestershire Drug and Alcohol Service (GDAS) and the Gloucestershire Constabulary launched the Alcohol Arrest Referral Scheme project (AARS). The scheme, the first of its type in the country, is not cell based and aims to minimise additional work for Custody Staff.

View the full project on HubCAPP: www.hubcapp.org.uk/B2VC

Leeds Pharmacy Brief Alcohol Interventions

In 2006, professionals from Leeds PCT and Leeds Pharmaceutical Committee collaborated to launch this innovative research project. The intention was to investigate the feasibility of community pharmacists incorporating IBA for increasing and higher risk drinkers as a routine part of their public health role.

View the full project on HubCAPP: www.hubcapp.org.uk/OFAT

More IBA Resources including IBA eLearning course and tools