A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care

BACKGROUND: Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs. AIMS: This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited. METHODS: The study design was qualitative, using a grounded theory approach to data collection and analysis. Semi-structured in-depth interviews were conducted with 24 nurses from practices that had previously been involved in a General Practitioner (GP) led brief alcohol intervention trial in the North-east of England. A combination of convenience and purposive sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. RESULTS: It was clear that although primary health care nurses have many opportunities to engage in alcohol intervention, most have received little or no preparation for this work. This has left nurses at a disadvantage as alcohol consumption is a confusing and emotive area for both health professionals and patients. An analysis of factors influencing nurse involvement in alcohol intervention outlined a requirement for clear health messages about alcohol, training in intervention skills, facilitation to enhance confidence regarding intervention and support to help deal with negative patient reactions. CONCLUSIONS: As current health policy is to encourage, sustain and extend the health promotion and public health role of primary care nurses, more attention should be given to providing them with better preparation and support to carry out such work.     

Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial

AIM: This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing excessive alcohol consumption among patients in primary health care. BACKGROUND: Excessive alcohol consumption is a major source of social, economic and health problems. However, such consumption is responsive to brief alcohol intervention. To date, brief intervention research in primary health care has focused on general practitioner-led interventions, and there is only circumstantial evidence of effectiveness in nurse-led interventions. However, nurses are increasingly taking a lead in health promotion work in primary care. METHODS: A pragmatic cluster-randomized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with standard advice (control condition). A total of 40 general practice clusters (intervention = 21 and control = 19) recruited 127 patients (intervention = 67 and control = 60) to the trial. Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test. After baseline assessment, patients received either a 5-10 minutes brief intervention using the 'Drink-Less' protocol or standard advice (control condition). Follow-up occurred at 6 and 12 months postintervention. RESULTS: Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up. A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement. Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service resource use relative to standard treatment. CONCLUSION: The brief intervention evaluated in this trial had no effect over standard advice delivered by nurses in primary health care. However, there was a reduction in excessive drinking across both arms of the trial over time. Due to nurse drop-out, this trial was significantly underpowered. Future research should explore barriers to nurses' involvement in research trials, particularly with an alcohol focus. A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care.     

Problem drinkers in accident and emergency: health promotion initiatives

Problems caused by excessive alcohol consumption often contribute to Accident and Emergency attendances, giving possible health promotion opportunities to this client group. These could include screening, health education (verbal or written), brief intervention and referral to alcohol services. Accident and Emergency staff rarely take these opportunities. A knowledge of alcohol problems, possible health promotion initiatives and services available alter attitudes and increase the likelihood of staff giving health promotion. Health promotion to problem drinkers should be a routine in Accident and Emergency departments.     

Current status of implementation in Japan of the WHO guidelines for cancer pain relief and future perspectives

The WHO guidelines have much improved cancer pain management in Japan. In 1987, the Ministry of Health established new policy on palliative care, revised narcotics control measures, and edited guidelines on palliative care. Thus, national cancer pain relief program has been implemented and relieved many cancer patients of their severe persistent pain. Annual consumption of morphine for medical purposes gradually rose to 973 kg in 1999, but the annual morphine consumption per capita is still less than one-sixth of that in the US. In order to further achieve program implementation, educational approach should be much more strengthened. It is also emphasized that each health care professional should recognize the ethics in pain relief and each hospital should urgently has its policy to achieve freedom from cancer pain for all throughout Japan.     

A theory-based implementation program for alcohol screening and brief intervention (ASBI) in general practices: Planned development and study protocol of a cluster randomised controlled trial

BackgroundPrevious studies have shown that alcohol screening and brief intervention (ASBI) in general practices can lead to significant reductions in alcohol consumption among patients, yet ASBI is rarely implemented into routine clinical practice. The aim of this paper is to describe the development and evaluation of an ASBI implementation program aimed at increasing ASBI delivery rates of general practitioners (GPs) and decreasing patients' alcohol consumption.Methods/designThis study protocol describes the step-wise development and evaluation of an ASBI implementation program. A four-step method is used to identify relevant determinants of change and intervention components based on the Behaviour Change Wheel and the Theoretical Domains Framework. The program will be evaluated in general practices in The Netherlands in a two-arm cluster randomised controlled trial which investigates the effect of the program on GPs' ASBI delivery behaviour as well as on patients' alcohol consumption.DiscussionEffective theory- and practice-based strategies to implement ASBI in general practices are highly needed. Using a stepwise method we described the development of a program consisting of an e-learning module, a tailored feedback module and environmental support and materials. We hypothesize that this program will result in an increase of GPs' ASBI delivery behaviour. Secondly, we expect an overall decrease in percentage of patients with excessive or problematic alcohol use and a higher proportion of patients from GPs receiving the ASBI implementation program decreasing their alcohol consumption, compared to patients from GPs in the control group.Trial registration: NTR5539     

Peer-led alcohol intervention for college students: A pilot randomized controlled trial

This study aims to assess the preliminary efficacy and feasibility of a brief, peer-led alcohol intervention to reduce alcohol consumption in binge-drinking Spanish nursing students. A pilot randomized controlled trial was conducted with 50 first-year nursing students who were randomly assigned either a 50-min peer-led motivational intervention with individual feedback or a control condition. Primary outcomes for testing the preliminary efficacy were alcohol use and alcohol-related consequences. Quantitative and content analyses of open-ended survey questions were performed. Participants in the intervention condition significantly reduced binge-drinking episodes, peak blood alcohol content, and consequences compared to the control group. Principal facilitators were completing the questionnaire during the academic schedule and providing tailored feedback through a graphic report. The main barrier was the unreliability of students' initial commitment. The findings suggest that a brief motivational intervention could be effective for reducing alcohol consumption and alcohol-related consequences in Spanish college students. Peer counselors and participants reported high satisfaction, indicating that the intervention is feasible. However, a full trial should be conducted taking into account the identified barriers and facilitators.     

Finnish attitudes to alcohol policy in 2005

This article gives an overview of changes in alcohol policy in Finland during the last decades and developments in public alcohol policy opinions revealed in the latest Gallup poll conducted on January 2005. During the last decades, all three pillars of the Nordic alcohol control policy—strict physical availability of alcoholic beverages, high alcohol taxes and prices, and the comprehensive alcohol monopoly system—has been weakened. At the same time, total alcohol consumption and alcohol‐related problems have increased. Public attitudes of alcohol policy have not always followed the changes in alcohol consumption and related problems. During the last decade, alcohol policy attitudes have become somewhat stricter. Besides increases in total alcohol consumption and related problems, since 1994 changes in drinking habits and contexts have affected alcohol policy attitudes, especially the abolishment of rules forbidding drinking in a public place leading to an increase in problem‐prone drinking and related behaviour in many kinds of public places like parks, playing grounds, streets and shopping malls. Also youthful drinking has become, if not more frequent, at least clearly more visible and more frequently discussed in the media.     

Screening,brief intervention,and referral to treatment (SBIRT) education of residential care nursing staff: Impact on staff and residents

Approximately 40% of older adults drink alcohol. Older adults living in community care residences are a vulnerable population at risk for alcohol use related problems especially for those age 65 years and older who are taking medications, have health problems, and have risky alcohol consumption. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach for individuals at risk for alcohol use disorders. A quality improvement project evaluated SBIRT education effects on nursing staff knowledge and attitudes related to alcohol use, and resident alcohol use. The staffs’ SBIRT knowledge and alcohol related attitudes increased significantly. The staff documented SBIRT intervention 231 times in three months’ post training.     

Screening for hazardous drinking in a population of well women

Previous research suggests that only about 15% of people who experience alcohol problems come to the notice of healthcare providers. Research has also shown that there is often a failure among healthcare providers to identify alcohol problems in patients whose primary presentation is not overtly alcohol related. It has been implied that this failure is contributed to by a lack of training and support on the part of the organization. This article reports on a project in which a group of health visitors were trained in a brief method of screening for and intervention with alcohol problems and then supported in identifying and intervening with women among their caseload who were drinking at unsafe levels. The sample comprised 430 'well women' between the ages of 18 and 45 years, with no known previous or current alcohol-related problem. All the women were on the caseloads of health visitors in one health board area and all women had children under the age of 16 years. It was found at screening that 13% of the sample consumed more than 14 units of alcohol per week. Consumption was measured 6 months after one session of minimal intervention, and it was found that 92% of the intervention group reduced their alcohol consumption. Mean consumption had decreased by 55%, from 21.11 units to 9.24 units per week. Among those women whose drinking had been at levels which were potentially problematic (capable of sustaining physical, psychological or social problems due to alcohol consumption), the mean weekly amount consumed decreased by 59% from 30.7 units weekly to 12.43 units.     

Making the link: a public health approach to preventing alcohol-related violence and crime

The public health and criminal justice fields have an unprecedented opportunity for collaboration. Both the 'broken windows' and the public health perspectives focus attention on actions in local communities to change the environmental factors that breed both alcohol problems and the crime and violence often associated with them. The paper introduces the public health perspective by reviewing the history of conceptualizations of alcohol problems in the United States, and showing how the public health perspective builds on and expands earlier views. Following a summary of research regarding causal links between alcohol and crime and violence, the paper summarizes research findings demonstrating the efficacy of policy options to influence alcohol environments, broken down into measures that counter each of the marketing elements of price, place, promotion and product. The paper concludes by underlining the importance of local action, organization and the development of advocacy skills, as well as the tremendous potential inherent in the nascent coming together of criminal justice and public health action to prevent alcohol-related crime and violence.     

Perceived availability of substances,substance use and substance‐related problems: a cross national study among French and Dutch adolescents

Aim. A cross‐national comparison of perceived availability of alcoholic beverages and cannabis, and of the influence of availability on consumption of and problems due to alcohol and cannabis.

Method. National surveys of school‐going adolescents (14–18 years) in France and the Netherlands were used. The questionnaire was comparable for all measures used in this study. We distinguished between problems with peers, with socializing agents and adverse events (e.g. fights). Cross‐tabulations and logistic regression were used for data analysis.

Results. Compared with the French, Dutch adolescents perceive alcoholic beverages and cannabis as more easily available. Among the youngest (up to 17 years) the country difference is very small (3–4%). Perceived availability is of influence on alcohol and cannabis consumption, and on problems attributed to alcohol or cannabis consumption. In the Netherlands, the influence of perceived availability on alcohol consumption is stronger. When controlling for other variables, French adolescents are more likely to report problems due to cannabis use.

Conclusions. The difference in cannabis policy between the two countries has a limited influence on perceived availability. Perceiving a substance as difficult to get prevents (frequent) use of alcohol and cannabis and prevents cannabis‐related problems. A stronger enforcement of existing alcohol laws is recommended for the Netherlands. There are differences between France and the Netherlands in problems attributed to alcohol and cannabis which cannot be interpreted in the context of differences in policy     

Alcohol use and problems in daily and non-daily coffee drinking college females

Background: For more than a decade, a large proportion of research on caffeine use in college students has focused on energy drinks (ED), demonstrating an association between ED consumption and heavy/problem alcohol use. The present study examined the relationship between daily coffee (DC) consumption and varied measures of alcohol use and problems in a sample of college women. Methods: Participants were undergraduate females (N = 360) attending an urban university in 2001–02 and prior to the rise in ED popularity on college campuses. Analyses compared women who reported drinking coffee daily (DC; 16.9%), to women who did not (non-daily coffee [NDC]; 83.1%) on standardized measures of alcohol use and problems. Results: For both past month and year of drinking, DC women generally reported consuming more alcohol and were 2.1–2.6 times more likely to screen at risk for alcohol problems than their NDC counterparts. DC women were also more likely than NDC women to report problems related to drinking (e.g., experiencing blackouts, inability to stop drinking after they had started). Conclusions: Findings support potential benefits of health education and screening that goes beyond EDs, focusing on varied forms of caffeine consumption.     

急性酒精中毒安全隐患原因分析及对策

目的探讨急性酒精中毒存在的安全隐患。方法将2009年12月-2012年12月急诊收治留院观察的508例急性酒精中毒患者进行安全隐患的原因分析并采取相应的安全对策。结果508例急性酒精中毒患者经全面查体评估病情、保持呼吸道通畅、建立静脉通道、加速体内乙醇排除、促醒、采取安全防护措施、加强医患沟通，未发生意外伤害和死亡。结论对急性酒精中毒患者存在的安全隐患应高度重视，只有采取相应的安全对策，才能确保患者的安全。     

Action on obesity: report of a mayo clinic national summit

In May 2004, representatives from local, state, and national public and private organizations met in Rochester, Minn, for the Action on Obesity Summit hosted by Mayo Clinic. The overall goal of this summit was to identify creative and effective strategies to Increase the US population's physical activity and improve nutrition to reverse the increasing prevalence of obesity. Ideas generated from selected abstract presentations and breakout sessions were prioritized and incorporated into an action model (available at www.actiononobesity.org) deemed feasible for implementation into most communities. Highlights of the presentations included a company that reported lower than expected health care expenditures secondary to a work site wellness program, a national initiative to increase physical activity (www.americaonthemove.org), and innovative work site nutritional strategies. The implementation model that emerged contained certain themes. Coordinated action at all levels will be required to substantially impact the increasing prevalence of obesity. Educational messages should be simple, consistent, tailored, and linked to benefits. Healthy food options in vending machines and restaurants and increased opportunities for daily physical activity should be available in schools, work sites, and communities. Legislative and policy changes should promote physical activity and improve nutrition. Support for research should be encouraged and outcome measures for interventions documented. A second Action on Obesity Summit is planned for June 9 and 10, 2005, that will review the progress made in the intervening year and continue to refine the implementation model to help address the obesity epidemic, one of the greatest public health problems facing the United States.     

安徽省人群高血压流行特征调查

目的了解安徽省成年人群高血压患病及流行特征。方法以多阶段随机抽样方法,抽取研究对象5038例,采用询问调查、医学体检方法收集资料。结果成年人群高血压患病率22.9%,标化患病率16.9%,高血压患病率男性高于女性,随年龄的增大,高血压患病率明显上升,小学以下文化程度人群、超重、长期过量饮酒、每天食用腌制品、缺乏水果类食物摄入者的高血压患病率高(P<0.01)。结论应加强对公众的健康教育,普及高血压防治知识,针对高血压高危人群采取干预措施。     

The burden of alcohol misuse on an inner-city general hospital

Alcohol consumption in the UK has been increasing steadily. We prospectively studied the burden on hospital services caused by overt alcohol misuse, in an inner-city hospital in north-west England. All Accident & Emergency (A&E) patients were assessed to determine whether their hospital attendance was alcohol-related, and whether this resulted in admission and/or generated new out-patient appointments. Over 2 months, 1915 patients attended A&E with alcohol-related problems, accounting for 12% of attendances; 50% were aged 18-39 years, and acute alcohol intoxication was the commonest presenting complaint. Overall, 6.2% of all hospital admissions were due to alcohol-related problems. Over 2800 new out-patient visits were likely to have been generated over an 18-month period from initial attendance with an alcohol-related problem, mostly for orthopaedic clinics. The burden placed by overt alcohol-related problems on hospitals is enormous, both in terms of the emergency and out-patient services. The implementation of education, screening and intervention strategies in A&E departments, and employment of key trained personnel, should be considered, to optimize the clinical management of these patients.     

Nurses' attitudes, beliefs and confidence levels regarding care for those who abuse alcohol: impact of educational intervention

Alcohol abuse is a worldwide public health concern. Nurses, representing the largest body of health care providers, are a potential resource to provide screening and brief intervention for patients with alcohol problems. This study evaluates the effect of an educational intervention on the attitudes, beliefs, and confidence levels of nurses regarding screening and brief intervention for alcohol problems. One hundred eighty-one students at Vanderbilt University School of Nursing participated in a four-hour educational intervention to train providers in brief negotiated intervention (BNI) for screening, early detection and brief treatment of alcohol problems. Participants completed questionnaires before and after this training. Analysis of the data using paired t-test and one-way analysis of variance showed statistically significant positive change in the nurses’ attitudes, beliefs, and confidence levels regarding alcohol abuse and its treatment after the educational intervention. For example, the percentage of nurses who reported always having confidence in assessing patients’ readiness to change their behavior increased from 8.3% to 23.5% after training. In conclusion, the BNI educational intervention can be effective in promoting positive changes among nurses in attitudes, beliefs, and confidence levels regarding alcohol abuse and its treatment.     

IKAP健康教育模式对军队在职疗养员生存质量改善作用的研究

目的探讨信息知识信念行为（IKAP）健康教育模式在军队在职疗养员中的应用。方法将112名部队在职疗养员采用随机数字表法分为对照组和观察组各56例,对照组给予常规护理及健康教育干预,观察组给予IKAP健康教育模式。观察两组疗养员干预前后自我保健知识掌握、实施效果、治疗依从性及疾病控制效果。结果两组干预后15 d自我保健知识掌握、实施效果、治疗依从性及疾病控制效果比较差异有统计学意义（P〈0.05）。结论将IKAP健康教育模式应用于军队疗养院,能提高疗养员自我保健知识掌握和实施能力及治疗依从性,从而有效促进健康。     

Prevention of alcohol-related harm

A two-pronged approach is needed to address alcohol-related problems - a population approach to reduce mean levels of alcohol consumption in the UK, and a targeted approach that focuses on ‘problem drinkers’. The British Medical Association (BMA) has investigated both approaches and developed policies to tackle health risks associated with alcohol. Most recently the BMA has recommended changes to the sensible drinking message which were regrettably not reflected in the UK government's new message on sensible drinking. The public needs clear information on the personal health risks of alcohol consumption and the problems presented for society. Problems for society, such as drinking and driving, accidents at work and impaired working performance due to alcohol, need to be highlighted separately and in addition to the personal health risks. Currently there appearr to be no downward trend in alcohol consumption towards Health of the Nation targets. A new approach is needed to ensure that the targets can be met by the year 2005.