Bridging the gaps between alcohol services: Patients at the centre of care

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Bridging the gaps between alcohol services
Patients at the centre of care

• Dr. Lynn Owens
• Nurse Consultant
• Honorary Research Fellow

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A Targeted Approach

• Over 5 million people aged 35-74 in England drink
  above sensible levels.
• Over two million of them drink everyday.
• High frequency drinkers are concentrated in older
  age groups

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An Ideal Response

• Range of services communicating with other,
  respecting differences, and supporting referral
  pathways into and out of care.

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Setting based on access lottery
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Setting based on patient needs
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What to do with none treatment seeking individuals

• Attending with co-morbid conditions or accidents
  and injuries.

• Link co-morbidity to consumption
• Offer treatment in context of after care
• Negotiate goals

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Motivating Patients toward change

• Feedback (From Nurse to Patient)
• - Personal risk or impairment concerned with
  co-morbid diagnosis (e.g. alcohol liver disease)
• - Drinking (Quantity and Frequency) utilising
  drink diary
• - Blood results
• - Nutrition (Diet/ Vitamins/hydration/BMI)
• Responsibility
• -Patients are encouraged to take responsibility
  for their own health behaviours and given
  information to empower their choices for change.
• Advice
• - On how to cut to cut down or abstain.
• Menu
• - Alternative options for changing drinking
  behaviour, setting a target agreeing goals of
  reduction.
• Empathic interviewing
• - Listening reflectively avoiding cajoling or
  confronting understanding the patients situation
  and their barriers or perceived barriers to
  change.
• Self efficacy
• An interviewing style which enhances peoples
  belief in their ability to change

Bien, Miller et al. 1993
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Modality based on patients needs/wants

• Alcohol brief advice
• Alcohol brief interventions
• Pharmacological management of AAW
• Adjunct pharmacological interventions
• Talking therapy intensive psychosocial
• Counselling

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Professional best placed to co-ordinate care

• Match treatment modality with clinician/interventi
  onist
• Hospital Nurse/ED consultant/gastroenterologist
• Specialist service psychiatrist/psychologist/nur
  se
• Community Health trainers
• Self Help peer support etc.

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Patient Choice

• The aim of the clinician is not always that of
  the patient.
• To meet targets to reduce hospital related
  admissions BEST FIT may be required.

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An Effective Pathway practice e.g.
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What works A prospective cohort study for
dependent drinkers
Owens, L. Cobain, K. unpublished
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What works A prospective cohort study for
dependent drinkers
Owens, L. Cobain, K. unpublished
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ConclusionWinning hearts and minds

• There is a wealth of people well placed to
  respond effectively.
• There are interventions of proven efficacy and
  effectiveness for a range of problem drinkers,
  from risky to dependent
• Leadership is a key function of effectiveness.