Alcohol screening and brief intervention in a policing context: A mixed methods feasibility study

Introduction and Aims. There is a strong association between alcohol and offending behaviour and 25% of police time involves alcohol‐related incidents. This pilot study aimed to investigate the feasibility of delivering alcohol screening and brief intervention (ASBI) to individuals arrested for offences linked to drinking behaviour. Design and Methods. Participants were detainees arrested for public order or assault offences in one North East police station in England. Following a 2 h training session, 10 Detention Officers (DOs) conducted ASBI over 3 months during routine police work. In‐depth interviews with the DOs provided further details about the acceptability of ASBI procedures. Results. Of 704 target arrestees, 229 (33%) agreed to participate in the study. Most were male (81%), white British (95%) and under the age of 30 (62%). Fifty‐nine per cent screened positively for an alcohol use disorder (50% were hazardous, 15% harmful and 35% dependent drinkers), although 23% detainees either refused or were unable to complete the screening tool. Of the 134 participants that screened positively, 98% were willing to receive brief intervention. DOs reported mixed views about ASBI; while half were positive about the process the remaining DOs expressed reservations about the appropriateness of the policing context for ASBI. Discussion and Conclusions. Despite limited training, DOs were able to deliver ASBI during routine police work. These findings provide a promising platform for future evaluative research on brief intervention outcomes in this setting. However, the issue of coercion needs to be explored more fully with both detainees and DOs.[Brown N, Newbury‐Birch D, McGovern R, Phinn E, Kaner E. Alcohol screening and brief intervention in a policing context: A mixed methods feasibility study. Drug Alcohol Rev 2010;29;647–654]     

Tobacco users' perceptions of a brief tobacco cessation intervention in community pharmacies

ObjectiveTo explore factors affecting tobacco users' perceived appropriateness of a brief and proactive tobacco cessation counseling program, ask, advise, and refer (AAR), at community pharmacies.DesignInductive thematic analysis.SettingSouthern Wisconsin during fall 2008.Patients24 tobacco users who had recently received brief and proactive tobacco cessation counseling at a community pharmacy.InterventionSemistructured telephone interviews conducted by primary author.Main outcome measuresPerceptions of a brief and proactive tobacco cessation counseling program conducted at community pharmacies.ResultsIn conducting the thematic analysis, eight distinct themes were identified. Display of information and resources at pharmacies for use by tobacco users as needed was identified as the most predominant theme and was found to be most helpful by many respondents. Other themes identified in decreasing order of prevalence were: tobacco users' perceptions of the role of pharmacists in health care, tobacco users' belief that smoking could interact with a current medication or health condition, tobacco users' sensitivity toward their tobacco use behavior or being told what to do, nonconfrontational and friendly approach of pharmacists, tobacco users' readiness to quit at the time of AAR counseling, tobacco user initiation of tobacco use discussion, and tobacco users' belief that tobacco use is bad.ConclusionOverall, this qualitative investigation suggests that several factors might influence tobacco users' perceived appropriateness of AAR counseling at community pharmacies. AAR might be well received by tobacco users and pharmacy patrons as long as it is done in a professional and respectful manner.     

Alcohol demand moderates brief motivational intervention outcomes in underage young adult drinkers

IntroductionThe Alcohol Purchase Task (APT), a behavioral economic measure of alcohol's reinforcing value (demand), has been used to predict the effects of Brief Motivational Intervention (BMI) on alcohol use outcomes. However, it is not known whether BMI may be more or less efficacious, relative to control, among those with different levels of alcohol demand prior to treatment.MethodsNon college-attending young adults (N = 150) reporting past-month heavy drinking were randomized to a single in-person session of BMI or a relaxation training control (REL). The BMI included delivery of personalized feedback and focused on developing discrepancy between the young adults' goals and their current pattern of alcohol use. At baseline, participants completed assessments of alcohol use and the APT. Drinking levels were re-assessed at 6 weeks and 3 months post-intervention. Demand indices derived from the APT were examined as moderators of treatment effects on follow-up drinking after covarying for baseline alcohol use.ResultsTwo of four APT demand indices – intensity and O_max - moderated treatment outcomes. Relative to REL, BMI led to greater reductions in total number of drinks consumed and drinks per drinking day among participants with higher baseline alcohol demand. This association was not observed among participants with lower levels of alcohol demand.ConclusionsThese results demonstrate that BMI may be particularly beneficial for those with a high reinforcing value of alcohol. The mechanism for this effect is unclear, and determining the process by which BMI confers increased benefit for these individuals is a fruitful area for future work.     

Potential normalization of an asthma mHealth intervention in community pharmacies: Applying a theory-based framework

BackgroundEffective mobile health (mHealth) interventions have been developed to support patients with their medication use, however to date few are widely used in pharmacy practice. Normalization of an intervention is essential to have a population impact, which is defined as ‘the process of getting a new intervention into routine practice’.ObjectiveThe aim of this study was to assess the normalization potential of a complex mHealth intervention for adolescents with asthma (ADolescent Adherence Patient Tool; ADAPT) in community pharmacy practice.MethodsThe Normalization Process Theory (NPT), a sociological action theory, was retrospectively applied to study the normalization potential of ADAPT. NPT explains factors that promote or hinder implementation, embedding, and integration of new interventions in clinical practice. Evaluation data (structured interviews and questionnaires) of 23 pharmacists who used the ADAPT intervention were used for this study.ResultsPharmacists understood the purpose of the ADAPT intervention and were prepared to undertake the necessary work of implementation. However changes at different levels are needed to support full normalization, such as changes in the intervention itself and changes in the pharmacist's work flow. The potential for normalization could also be enhanced by the use of product champions and appropriate reimbursement guidelines, to ensure uptake of the intervention by other pharmacists. Support from professional bodies for the use of mHealth could also promote normalization.ConclusionsNormalization of mHealth is a complex continuous process. The ADAPT intervention has the potential to be normalized in community pharmacy practice, but full normalization would require changes in both daily pharmacy practice and reimbursement models.     

Adoption of a biometric screening service in community pharmacies: A qualitative study

ObjectiveTo explore differences in perceived attributes of biometric screening services and organization characteristics among community pharmacies that adopt, outsource, or do not adopt biometric screening services that assess patients’ blood pressure, blood glucose, serum cholesterol, and body mass index.DesignQualitative, comparative analysis.SettingIndependently owned community pharmacies in Alabama.Participants25 key informants from community pharmacies were classified as adopters, outsourced adopters, and nonadopters of biometric screening services. Pharmacies using in-house staff to conduct screenings are referred to as adopters; those using external staff are referred to as outsourced adopters.Main outcome measuresPerceived attributes of the screening service and organizational characteristics identified through emergent theme analysis based on the Diffusion of Innovations Model and Model of Innovation Assimilation.ResultsThe screening service was perceived differently by adopters, outsourced adopters, and nonadopters. Adopters saw the opportunity to increase revenue and expand the role of the pharmacist in health care by offering the service. Adopters also perceived the service to be compatible with their pharmacy layout and organizational identity; simple to implement; modifiable in terms of experimentation with models of service delivery; and visible by external constituencies (which positively affects pharmacy image). In contrast, nonadopters felt the amount of time, investment, and lack of potential patients associated with the service influenced their decision not to adopt it. Adopters and nonadopters differed in regard to their innovativeness in patient care services, their connectedness in professional networks, and how they make sense of and deal with the uncertainty of new programs. Outsourced adopters were similar to adopters but were more cautious in their decision making.ConclusionPerceived attributes of the screening service and organizational characteristics differed among adopters, outsourced adopters, and nonadopters.     

The Adolescent Cannabis Check-Up: feasibility of a brief intervention for young cannabis users

In this study, we assessed the feasibility and effectiveness of the Adolescent Cannabis Check-Up (ACCU), a brief intervention for young cannabis users. For this initial feasibility study, we used an uncontrolled pre-test/post-test design. Participants were cannabis users aged between 14 and 19 years (n = 73) and concerned parents (n = 69). The intervention comprised an individual assessment session followed 1 week later by a session of personalized feedback delivered in a motivational interviewing style. An optional third session that focused on skills and strategies for making behavioral change was offered. Of the entire sample of cannabis users, 78% reported voluntarily reducing or stopping their cannabis use during the 90 days to follow-up and 16.7% reported total abstinence during this time. In addition, significant reductions were found on measures of both quantity and frequency of use and dependence. These reductions were maintained at 6-month follow-up. Clearly, these preliminary findings must be interpreted with caution given the study design and absence of a control group. The ACCU was, however, able to attract and retain young cannabis users who were not necessarily interested in change. The approach was acceptable to young people and associated with reductions in cannabis use. It appears to be a model that warrants further research in early and brief interventions for this population.     

Effectiveness and sustainment of a tailored over-the-counter medication safety intervention in community pharmacies: A randomized controlled trial

IntroductionThe Senior Section is a continuation of a previous intervention that aims to address a gap in medication safety, specifically related to older adult selection and use of over-the-counter medications. The purpose of this paper is to describe the protocol of this study.MethodsThis study will occur in three phases: an adaptation phase, an effectiveness phase using a randomized controlled trial, and a sustainment phase. This study will take place in conjunction with administrative leadership and pharmacy sites of a regional Midwest integrated health system. Eye tracking technology will inform the adaptation of the intervention and demonstrate effectiveness in the randomized controlled trial. Following the randomized controlled trial, the health system will implement the intervention without research team support. Fidelity and long-term effectiveness outcomes will be collected to demonstrate sustainment.DiscussionThe potential implications of this study are a complete and sustained redesign of the pharmacy setting to include educational and directional materials on medication safety, leading to a decrease in over-the-counter medication misuse in older adults. This project could provide a road map for pharmacy organizations to tailor and adopt the Senior Section, to ultimately reduce inappropriate over-the-counter medication use in older adults.     

Provision of smoking cessation services in Australian community pharmacies: a simulated patient study

Background With the rising interest in expanding pharmacists’ role in smoking cessation, it is pertinent that community pharmacists be equipped with up-to-date knowledge and competence to provide optimal therapeutic services that meet the demands of various presenting subsets of smokers. Objective To investigate and evaluate responses to requests of quitting smoking from ‘high risk’ smokers seeking assistance and treatment within the pharmacy venue. Setting Community pharmacies located within Sydney greater metropolitan area, New South Wales, Australia. Method A simulated patient methodology was utilised. Two scenarios were developed and enacted by two trained simulated patients in 100 randomly selected pharmacies. Scenario 1 involved a 28-year-old pregnant female who presents with a request for help in quitting smoking. Scenario 2 involved a 22-year-old female requesting a quit smoking product for her 55-year-old father who has cardiovascular problems. A standardised scoring key was designed to assess the performance of pharmacists during each encounter. Main outcome measure The primary outcome measure was the supply/non-supply of nicotine replacement products and the corresponding provision of counselling and advice to facilitate smoking cessation. Results A product(s) was supplied in 42 % of the 100 encounters, while a product was adequately suggested pending doctor’s referral in 45 %. In 13 % of the cases, a product was not supplied based on inappropriate notions of nicotine replacement therapy not being safe in the presented scenario. Pharmacists performed better in dispensing scores (counselling about product use) as compared to pre-dispensing scores (eliciting patient history). ANOVA followed by regression analysis indicated that the estimated age and gender of the pharmacist/staff were significant predictors affecting total scores. Conclusion Whilst pharmacists’ counselling about smoking cessation aids seems satisfactory, further education is required to improve practice standards in terms of matching a patient’s history and smoking status to an appropriate product.