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A prescription for tackling riskier drinking

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Published on 16 February 2017

Riskier drinking
Riskier drinking

While Dry January may have offered social drinkers an opportunity to reflect on their consumption and given their body a break from alcohol after the festive period – the next frontline in challenging the UK’s excess drinking culture could become the high-street pharmacy.

The University of Sunderland, working in partnership with The Drinkaware Trust, is evaluating a pilot study to test the feasibility of introducing into community based chemists Alcohol Brief Interventions (ABIs), which promote awareness around the health risks of alcohol misuse.

ABIs are based on a short self-completing questionnaire, developed by the World Health Organisation, asking a person about their drinking patterns.  On completion of the questionnaire the participant receives a summary score which highlights their likely level of health risk from their current alcohol consumption. The person delivering the intervention can then provide brief personally tailored information about the benefits of cutting down if appropriate.  They may also highlight where to obtain further advice or arrange an onward self-referral to more specialist support. They are generally used in primary care and GP practice settings and have proved an effective means of intervention.

Pharmacy outlets are considered the next obvious ‘parallel setting’ to deliver health promotion messages, due to the health focus, staff specialist knowledge and their location within local communities. People visiting may be seeking advice or waiting for a prescription, offering ‘windows of opportunity’ for engagement: as purchases may in some instances be related to ‘remedies’ for drinking too much, or could involve prescriptions for medicines to treat symptoms often related to a chronic over-consumption of alcohol such as stomach acid suppressants or high blood pressure medication.

However, the background to this project has also highlighted that in previous evaluations by other research groups, community pharmacists appear to have had no effect in reducing hazardous or harmful alcohol consumption, prompting questions as to why this might be the case. Investigators have speculated on the explanation being attributed to anything from the variable attitudes of pharmacy staff to the additional time and resource constraints associated with modern pharmacy practice.

Leading the research, John Mooney, Senior Lecturer in Public Health and Programme Lead for MSc in Public Health, said: “Through our evaluation we want to question why Alcohol Brief Interventions in certain pharmacies nationally have not worked, when they have proved so effective in Primary care and GP settings. There could be a number of reasons, from resource to time constraints on staff; therefore we should be wary of disregarding the pharmacy setting for ABIs.

“Essentially the pilot aims to examine how best to integrate ABIs, as unobtrusively as possible into the day-to-day working of the pharmacy.”

The current Drinkaware national campaign (‘Have a little less’) of which the pilot initiative is a part, has been running to coincide with 'Dry-January'. With a particular focus on working age men aged between 45-64, the message is that ‘Having a little less’ alcohol can have significant health benefits. This is in line with an expert consensus around some of the potential drawbacks of an over-emphasis on just one month of the year, and it’s believed there’s a great benefit to the target audience in reducing the amount of alcohol consumed on a regular basis.

John Mooney explained: “With long term trends in UK consumption still on the rise and a 44 per cent increase since 2009 in those aged 50 and over accessing alcohol treatment, all initiatives exploring innovative ways of getting the message across are to be welcomed. Don’t be too surprised therefore if you are asked about alcohol consumption the next time you collect a prescription!”

Drinkaware’s Director of Evidence and Impact, Dr John Larsen, added: “We know that there is encouraging evidence that alcohol brief interventions can make a difference in many fields where this has been tried, and we are excited about working with researchers at the University of Sunderland to test how an easy, fun and engaging way to deliver this in pharmacies and other settings will be received by staff delivering this and the people we are hoping will benefit.”

Mark Burdon who is a member of the Pharmaceutical Services Negotiating Committee (PSNC), Fellow of the Royal Pharmaceutical Society (RPS), and an independent contractor who owns a number of pharmacies in the region, The Burdon Pharmacy Group, commented on the pilot study. He said: “Community pharmacies are accessed by 1.6m people each day; with most of these people obtaining a medicine or purchasing healthcare products. Pharmacy staff don’t just advise on the use of medicines, but are increasingly involved in helping people to improve their health. We know that community pharmacies are an ideal place for this activity, but we need tools to help maximise the benefits.

“Discussing alcohol consumption can be difficult and we are interested to see the outcome of this pilot study.”

Other potential strengths of pharmacies as a setting for ABIs might be the now well established practice of providing support to pharmacies looking to embrace a wider health promotion role. As part of NHS England’s current ‘Promotion of Healthy Lifestyles’ programme, pharmacies are now required to participate in up to six health promotion campaigns per year. This generally involves the display and distribution of leaflets provided by NHS England or other collaborating institutions or stakeholders. As a result, there are usually highly visible and engaging ‘health promoting and awareness raising materials’ adorning the display areas of high street pharmacies and messages around alcohol health risks and reducing them are often a focus of such displays.