The Feasibility and Effectiveness of the Provision of Alcohol Screening and Brief Advice in Pharmacies for Women Accessing Emergency Contraception (EHOC)

1
The Feasibility and Effectiveness of the
Provision of Alcohol Screening and Brief Advice
in Pharmacies for Women Accessing Emergency
Contraception (EHOC)
2
Background

• potential of community pharmacies as a setting
  for health promotion advice
• gap in the evidence on screening and brief advice
  in a pharmacy setting
• pilot in County Durham and Darlington for women
  accessing community pharmacy for EHOC
• funded by PCT and DH
• the Evaluation, Research and Development Unit
  (ERDU) at Durham University agreed to evaluate
  the initiative

3
Strands of the evaluation

1. Interviewing pharmacists about the implementation
   and acceptability of the initiative
2. Interviewing clients identified as low risk to
   understand their perceptions of the initiative
3. On-line surveys with the risky group to
   evaluate the impact of the initiative on alcohol
   consumption and contraceptive behaviour as well
   as their perceptions of the initiatives

4
Process
5
Study procedure
6
Project Timeline
7
Promotional campaign
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Key Findings

• uptake by pharmacists was low initially.
• in first 6 months only 26 pharmacists took up
  training and only 13 were regularly screening
  clients
• by Nov 2011 the number had doubled as HCAs could
  assist (NICE) and participants were offered a
  voucher for participating in the study (3/6 month
  follow up)
• barriers included time, conflicting demands,
  confidence with the AUDIT tool, raising a
  sensitive topic with clients

9
Key Findings

• mean age was 21.9years (range from 14 - 48 years)
• there was an increase in AUDIT score between
  baseline and 3 months however the mean difference
  in AUDIT score between 3 and 6 months reduced by
  1.12-2 points (need a larger sample)
• after 3 months follow up no women reported having
  used EHOC again after the intervention, though 4
  did at 6 months. However increase in use of oral
  contraception and LARCs.

10
Key Findings

• at baseline 12 women reported they had sex they
  regretted, only 3 reported this at 6 months
  follow up.
• at baseline 3 women reported they has sex that
  was forced on them/non-consensual and none at 6
  month follow up
• clients felt it was appropriate and acceptable
  for the pharmacist to carry out alcohol screening
  and deliver alcohol advice

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Strengths and limitations

• need consistency in data collection method i.e.
  face to face then on-line
• fewer participants/pharmacists were recruited
  than anticipated
• the mean change in AUDIT score was significant
  but small, results have to be interpreted with
  caution given the large CIs
• fees were not an incentive for pharmacies, they
  felt they were making a difference rather than
  just giving out medication

12
Next Steps

• expansion of the scheme to cover more conditions
  which may be associated with alcohol misuse
  including gastric problems, falls, high blood
  pressure, depression/anxiety/stress, pregnancy or
  for MURs
• 86 pharmacists now trained to deliver alcohol
  screening (74 County Durham and 12 Darlington)
• regular use of AUDIT has increased skills of
  pharmacists
• links to annual campaigns in particular in
  alcohol awareness week