ALCOHOL CARE PROVISION 2013

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1 . In 2013 NHS Health Scotland on behalf of the Scottish Government commissioned research by Iconic Consultants. The aim of the research was to assess the availability, demand, utilization and capacity of alcohol treatment service providing specialist tier 3&4 intervention across Scotland; this important piece of research is part of the wide ranging programme to monitor and evaluate Scotland s alcohol strategy (MESAS) As part of the study, all alcohol services providing tier 3 and 4 interventions were recently invited to take part in a survey to gather vital information on their services and service users. This is still in progress and visit dates are due to follow. This development has come at an opportune time for the partnership and will compliment our own review processes which were feedback at the last Full ADP meeting Making Progress at the end of This is an ongoing review process and aims to facilitate the Redesign and Workforce Development strategies. Within the review of present care provision and with the PLACE model being considered within Aberdeenshire there have been opportunities identified to evaluate our present alcohol service provision. At the recent SMS Conference the ADP Support Team had an information stand where a, Vox Box, was available for collecting comments. The response to this was good and data collection reflected the mixed audience who attended and their views on the provision of Alcohol services within the Aberdeenshire area. VOX BOX data Do you feel there is a proper balance of service provision between Alcohol Services & Drug Services in Aberdeenshire? Yes No Don't Know What Detox options for Alcohol dependency would you like to see in Aberdeenshire? Self Detox Supervised Home Detox Inpatient Detox None of the above 0

2 Aberdeenshire GP Feedback In late 2013 the ADP Support Team distributed to all GP practices within Aberdeenshire a questionnaire specifically to analyse service provision and service need to those identified as having alcohol dependant patients (ICD10) within their practice area over a 12 month period ( ) This was a simple questionnaire requesting information specifically in relation to Detoxification within their community. Its aim was to identify the availability of preventative measures: in relation to the complications of prolonged harmful drinking such as ARBD (Alcohol Related Brain Damage). There are clear variations of availability over the geographical area for treatment, intervention and support identified from the questionnaire for those requiring assistance. Questions within the questionnaire: How many dependant alcohol clients where know of to their practice? What alcohol services are provided in the area? How many clients required Detox in the past year? How many clients required Pabrinex? Who administered the Pabrinex? How was this Detox managed and where? I.e. related to supervised/supported by; self, GP, pharmacist, CPN, Community Hospital, Rehab. In relation to the previous question what service improvement would be of benefit for the care and treatment for your client group in this area? Please tick the appropriate boxes below. There was also a free type option for any other comments within the questionnaire. Although the questionnaire has a relatively low response rate, it still produced relevant data which highlighted the following issues. Detoxification is the careful and planned withdrawal of alcohol, which carries clinical risks and which therefore, requires careful clinical management (SIGN 2003) Supported home Detoxification is a treatment designed to control both the physiological and psychological complications which may occur temporarily after a period of heavy and sustained alcohol use (Stockwell et al 1990).

3 From the 5 GP surgeries who responded it was estimated 147 dependant drinkers were know within their areas. Of those 147 dependant drinkers 7.5% received interventions to effectively assist them to achieve abstinence and recovery. 75% of GP respondents expressed a need for specialist CPN supported home detox as a main asset to the provision of services for those experiencing physical dependency to alcohol. The GP response also emphasised a need for access to day/ community hospital addiction beds (Some surgeries reported difficulties in sourcing the data in question within their systems) The questionnaire was designed to evaluate the use of medication such as Pabrinex within detox practice: The use of Pabrinex was NIL. Pabrinex has a protective action on the nervous system of those who misuse alcohol. Pabrinex injections provide vitamins B and C to people who have low vitamin levels. Low vitamin levels are common in people who drink too much alcohol and don t eat very much. Low levels of these vitamins can cause poor memory, confusion, pins and needles and other problems. Pabrinex injections boost the vitamin levels quickly to treat these problems or prevent them happening to you. A guide to good practice in the prevention of ARBD (Alcohol Related Brain Damage).

4 The ADP Support team has also completed an audit of prescribing activity directly in relation to the Prevention, Protection & Recovery of those suffering from Alcohol Dependency.

5 These graphs demonstrate the varying need and the prevalence of alcohol dependency within each GP practice area and would be of use in relation to Place and meeting the Needs of the community.

6 More analysis of these data sources is recommended to extract further detail in the practice and availability of detox from Alcohol and directly influence redesign and workforce development. The response from GPs and from the SMS Conference audience also demonstrates a willingness and motivation to influence change within our community and organisations. Recommendations Further work is to follow shortly from the ADP Support Team to look at the current provision of residential and community detox service within Grampian, this will consider the points below, and will be an integral part of the service redesign agenda. Items to be explored include - Unsupervised.GP Diazepam based detox within the community Use of preventative medication Inappropriately use of acute beds Availability of rehab in relation to recent funding issues associated to the Alexander Clinic in Old Meldrum Varied availability of interventions to enable individuals road to recovery Review of risk assessment processes specifically in relation to Vulnerable Adult, Incapacity, GIRFEC; (Getting It Right for Every Child) & IPSU; (Impact of Parental Substance Use).

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