Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences
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Background Studies indicate that community pharmacy-based alcohol brief intervention (BI) is feasible. However, few studies report significant reductions in post-BI alcohol consumption and customer experience. Cost-effectiveness has not been previously examined. Objectives This 5 month study adopted a single group pre- and post-experimental design to: (1) assess uptake of the community pharmacy alcohol BI service; (2) establish post-BI changes in alcohol consumption for hazardous drinkers; (3) report the acceptability of the service to customers who received it; and (4) undertake a preliminary economic evaluation of the service through establishing whether pharmacy-based alcohol BI affected health and social care costs, including lost employment costs, and whether it was cost-effective. Setting 26 community pharmacies in south London, UK. Method Trained pharmacists used the AUDIT-C and a retrospective 7-day Drinking Diary to identify risky drinkers and inform feedback and advice. Harmful drinkers were referred to their general practitioner and/or specialist alcohol services. A confidential service feedback questionnaire was completed by alcohol BI recipients. Baseline and 3-month follow-up telephone interviews were conducted with hazardous and low risk drinkers to assess post-BI alcohol use change and service cost-effectiveness. Main outcome measures AUDIT-C, 7-day alcohol unit consumption, drinking days, cost utilisation data. Results Of the 663 eligible customers offered alcohol BI, 141 (21 %) took up the service. Three-quarters of customers were identified as risky drinkers. Follow-up interviews were conducted with 61 hazardous/low risk drinkers (response rate = 58 %). Hazardous drinkers were found to significantly reduce their 7-day alcohol unit consumption and drinking days, but not AUDIT-C scores. The majority of harmful drinkers (91 %, n = 10) who were contactable post-BI had accessed further alcohol related services. Customer feedback was generally positive. Over 75 % of customers would recommend the service to others. The cost of delivering the service was estimated to be £134. The difference in service costs pre-BI and post-BI was not statistically significant and remained non-significant when calculated on 500 customers receiving the intervention. Conclusion Community pharmacy-based alcohol BI is a low cost service that may not have immediate beneficial impact on health and social service use, but can be effective in reducing drinking in hazardous drinkers.
KeywordsAlcohol Brief intervention Community pharmacy Cost-effectiveness Hazardous drinking Screening United Kingdom
We thank the pharmacists, support staff and service users who contributed to this study and Dr Abu Mohiddin, NHS Lambeth, Public Health Directorate, Dr Karen Rosenbloom, King’s College London, Institute of Pharmaceutical Science and the King’s College London & Lambeth PCT Brief Intervention Service in Community Pharmacy Settings Steering Group for their input into the service evaluation design.
This service evaluation was funded by a New Services and Innovations in Healthcare grant by the Guy’s and St Thomas’ Charity.
Conflicts of interest
- 2.Babor TF, Higgins-Biddle JC. Brief intervention for hazardous and harmful drinking: a manual for use in primary care. Geneva: World Health Organisation; 2001.Google Scholar
- 3.National Institute for Health and Clinical Excellence. Alcohol-use disorders: preventing the development of hazardous and harmful drinking. London: National Institute for Health and Clinical Excellence. 2010. Available at: http://www.nice.org.uk/guidance/PH24. Accessed 1 July 2013.
- 4.Kaner EF, Dickinson HO, Beyer FR, Campbell F, Schlesinger C, Heather N, et al. Effectiveness of brief interventions in primary care populations. Cochrane Database Syst Rev 2007, Issue 2. Art. No.: CD004148. doi: 10.1002/14651858.CD004148.pub3.
- 9.Department of Health. Choosing health through pharmacy—a programme of pharmaceutical public health 2005–2015. London: The Stationery Office; 2005.Google Scholar
- 10.NHS Future Forum. NHS Future Forum: summary report—second phase. London: Department of Health, 2012. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_132085.pdf. Accessed 1 July 2013.
- 11.National Audit Office. Health resource allocation: a briefing for the House of Commons Health Select Committee. London: The Stationery Office, 2010. Available at: http://www.nao.org.uk/publications/1011/health_resource_allocation.aspx. Accessed 1 July 2013.
- 12.Dhital R. Feasibility and usefulness of setting up an alcohol screening service in community pharmacy [MSc dissertation]. London: University College London; 2004.Google Scholar
- 16.Dhital R, Greene R, Lovejoy A. Feasibility of an alcohol screening service in a community pharmacy. Int J Pharm Pract. 2005;13(Suppl 1):R84.Google Scholar
- 20.Fitzgerald N, Stewart D. Drinking interventions in pharmacies study (DIPS). Aberdeen: School of Pharmacy, Robert Gordon University, 2006. Available at: http://alcoholresearchuk.org/downloads/finalReports/AERC_FinalReport_0038.pdf. Accessed 1 July 2013.
- 28.Beecham JK, Knapp MRJ. Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wing JK, editors. Measuring mental health needs. London: Gaskell; 1992. p. 163–83.Google Scholar
- 29.World Health Organization. The drink-less program. Available at: http://www.sswahs.nsw.gov.au/sswahs/Drinkless/. Accessed 1 July 2013.
- 30.Drinkaware. Unit & calorie calculator. Available at: https://resources.drinkaware.co.uk/unit-calorie-calculator. Accessed 1 July 2013.
- 31.Department of Health. Units and You. London: Crown copyright, 2008. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_085427.pdf. Accessed 1 July 2013.
- 32.Curtis L. Unit costs of health and social care 2009. Canterbury: Personal Social Services Research Unit; 2010.Google Scholar
- 35.Watson MC, Stewart DC, Inch J, Jaffray M, Duncan E, Afolabi E. Screening and brief interventions for alcohol misuse delivered in the community pharmacy setting: a pilot study (2011). Available at: http://www.cso.scot.nhs.uk/Publications/ExecSumms/JuneJuly11/WatsonPH.pdf. Accessed 1 July 2013.
- 38.Heather N. The case for extended brief interventions. Zdrav Var. 2012;50(1):1–11.Google Scholar