a&e and alcohol services peter rice, consultant psychiatrist, nhs tayside
TRANSCRIPT
A&E and Alcohol Services
Peter Rice,Consultant Psychiatrist,NHS Tayside
“Society is changing. There’s a reduction in trauma e.g. car accidents, but much more chronic illness” (Senior Nurse)
Inequalities, Health and the Accident and Emergency ResponseNHSGGC Anne Bryce 2010
British Liver Trust / ONS 2009
UK MORTALITY TRENDS
Male Cancer Deaths in Scotland 1997 - 2007
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Liver Cirrhosis Death Rates 1950 – 2006 :An International Comparison
Chronic Liver Disease Mortality by Deprivation, Scotland (Men)
Male mortality rate for chronic liver disease per 100 000 population, 1980-2002
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6 7
Deprivation category
dea
ths
per
100
000
p
op
ula
tio
n
1980-82
1991-92
2000-02
Attendees at NHSGGC A&E units more often come from the poorest communities in Glasgow, including marginalised groups such as asylum seekers and refugees, where chronic ill-health, reduced personal resources and problematic lifestyle behaviours are both the cause and consequence of an experience of poverty, social exclusion and poor social support.
Inequalities, Health and the Accident and Emergency ResponseNHSGGC Anne Bryce 2010
“Problems are upstream….A&E can only pull them out the water, patch up and return to the community” (A&E Manager
Inequalities, Health and the Accident and Emergency ResponseNHSGGC Anne Bryce 2010
What works?
International Review of Policy Measures
Authored by Public Health Academics
Sponsored by WHO
Strategy Measure EffectPrice Controls Taxation graduated by strength
Controlling cheapest price
High
? High
Treatment Brief Interventions
Intensive treatment for dependence
High
High/Mid
Availability Enforced age limits
Restricted hours
Retail monopolies
Outlet Density
High
Mid
Mid
Mid
Safer Environment
Enforcement of licensing codes
Server Training
Mid
Mid
Marketing Limiting exposure to advertising Low
Education and Information
Integrated campaigns
Classroom Education Only
Public Campaigns / Warning Labels
Low
Nil
Nil
Alcohol Statistics Scotland 2011
RECENT AFFORDABILITY TRENDS
On trade Beer
Off trade beer
SCOTTISH ALCOHOL CONSULTATION 2008
- A Minimum Price for Alcohol
- No discounts for multiple purchase
- Separate areas and checkouts in stores
- Age limit of 21 in off sales
- Social responsibility fee
- More support and treatment
- Coronary Heart Disease- Children’s Dental Care- Childhood Obesity- Suicide Prevention- Smoking Cessation- Breastfeeding and…….
Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11
HEALTH IMPROVEMENT TARGETS 2008
SCOTTISH ALCOHOL BILL 2010
- Principle of social responsibility levy.
- Ban on discount for multiple purchase.
- Confining promotional material to alcohol display area.
- Compulsory age verification policy (under 25)
- Licensing boards to consider ban on off-sales to under 21s.
- Minimum price per unit of Alcohol
“Staff can’t do everything that is asked of them. Some staff are able to do this well because of their interest and personality, others not….Like ABI (Alcohol Brief Intervention) we will consider what part of the intervention we can do and try to tailor to the department – like raising a concern with the attendee and giving them information” (Senior Nurse)
Inequalities, Health and the Accident and Emergency ResponseNHSGGC Anne Bryce 2010
“No time for staff to undertake brief interventions. May be possible through fracture clinic but not in ED” (A&E Manager)
WHAT IS A&E’s ROLE ?
1000 pts in study across 14 sites.
Intervention delivered by A&E staff with option of onward referral
Treatment group 10 min BI / Control group written handout
Treatment group reduced consumption at 3/12 but effect not sustained.
SCREENING TOOLS
•Brief•Reliable•Deliverable
Paddington Alcohol Test (PAT)
Fast Alcohol Screening Test (FAST)
MESSAGES SO FAR
There’s a lot of it about
You don’t win them all
A&E Staff can be influential, but so can others
Brief Interventions can start change process
But less likely to be effective as dependenceincreases.
Scottish Alcohol Needs Assessment 2009
DOES THE SERVICE MEET THE (POTENTIAL) DEMAND ?
Ratio of Service Capacity : Demand
Trends in Consumption and Mortality
Mortality and Consumption go together.
Mortality changes quickly.
Recent fall in consumption. - Rise in excise duties- Falling incomes- Destocking