a&e and alcohol services peter rice, consultant psychiatrist, nhs tayside

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A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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Page 1: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

A&E and Alcohol Services

Peter Rice,Consultant Psychiatrist,NHS Tayside

Page 2: 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

Page 3: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

British Liver Trust / ONS 2009

UK MORTALITY TRENDS

Page 4: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

Male Cancer Deaths in Scotland 1997 - 2007

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Page 5: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

Liver Cirrhosis Death Rates 1950 – 2006 :An International Comparison

Page 6: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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

Page 7: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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

Page 8: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

“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

Page 9: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

What works?

International Review of Policy Measures

Authored by Public Health Academics

Sponsored by WHO

Page 10: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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

Page 11: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

Alcohol Statistics Scotland 2011

RECENT AFFORDABILITY TRENDS

On trade Beer

Off trade beer

Page 12: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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

Page 13: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

- 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

Page 14: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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

Page 15: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

“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 ?

Page 16: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside
Page 17: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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.

Page 18: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

SCREENING TOOLS

•Brief•Reliable•Deliverable

Paddington Alcohol Test (PAT)

Fast Alcohol Screening Test (FAST)

Page 19: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

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.

Page 20: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

Scottish Alcohol Needs Assessment 2009

Page 21: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

DOES THE SERVICE MEET THE (POTENTIAL) DEMAND ?

Ratio of Service Capacity : Demand

Page 22: A&E and Alcohol Services Peter Rice, Consultant Psychiatrist, NHS Tayside

Trends in Consumption and Mortality

Mortality and Consumption go together.

Mortality changes quickly.

Recent fall in consumption. - Rise in excise duties- Falling incomes- Destocking