Alcohol ABC for General Practices and Maternal & Child Health Services Project Agnes Hermans, Project Co-ordinator Alcohol Northland PHOs agnesh@manaiapho.co.nz
Alcohol - it s as easy as..abc Overall project goal: to improve health outcomes through early intervention in reducing alcohol-related harm Method: integrate the ABC Approach into the everyday practice of all primary healthcare workers Evidence: provision of brief advice within primary health care setting effective at reducing harmful drinking
ABC Project in Primary Health Care Demonstration Project in Whanganui Regional PHO 2010 - Screening and Brief Intervention can work in a primary care setting - Within 1 yr, 33 GPs & 70 practice nurses screened 43% of enrolled patients - Interventions made for 36% of patients screened Follow up sample suggested that nearly 60% of Maori and 50% of non-maori screened reduced their consumption From there ABC Alcohol Project piloted in Manaia, Whanganui and Waitemata PHO s
Alcohol ABC Approach A : Ask B : Brief advice C : Counselling
Alcohol ABC Ask about alcohol (all patients over 15) AUDIT C tool: How often do you have a drink containing alcohol? How many standard drinks containing alcohol do you have on a typical day? How often do you have six or more drinks on one occasion?
Alcohol ABC Provide Brief Advice Use the full 10-question AUDIT tool Offer brief, structured individualised advice about appropriate levels of alcohol consumption for them in the context of their age and relevant health conditions
Alcohol ABC Offer referral to Counselling services in-house trained practitioner printed and online resources DHB AOD service Alcohol Drug helpline
Alcohol ABC Approach is adapted to the different needs of each practice Local referral services differ across the region Use community networks to identify appropriate pathways
IT Tools MedTech Patient Dashboard Items shown on Dashboard are specific to the age, gender and medical history of patient Traffic light colour coding to flag the status of alcohol recording: Red: Alcohol status not recorded Yellow: Alcohol use above guidelines or under surveillance Green: Alcohol use within guidelines
Dashboard Screen Shot
Recording Patient Alcohol Status Integrate into PMS AUDIT C (3 question) and AUDIT (10 question) tools Patient answers on AUDIT tools / declines to answer Standard drink calculator Pregnancy status National & local referral information / links to appropriate resources Detailed clinical assessment / clinician notes An Advanced Form has been developed to implement the ABC Alcohol Approach.
Practice Training ABC Alcohol programme is opportunistic Successful implementation relies on support and full involvement from all practice staff - Role and skills required by primary care teams in prevention, early detection and management of alcohol - Introduction to screening, brief interventions and basic info e.g. continuum of use, standard drinks - Useful websites Professional Competencies and Training
Alcohol Champions Practices to identify an alcohol champion within the practice to lead the project Attend a one-day training on alcohol harm, motivational interviewing and basic counselling Lead practice-based training for all practice staff
Implementation Follow up support and mentoring Patient recalls for follow-up visits Re-screening: Aged 15-25: annual Aged 25-35: every 3 years Over 35 within recommended guidelines: every 5 years Those with a hazardous drinking problem: annual until status changes
Alcohol ABC 2012 - Outcomes
Alcohol ABC 2012- outcomes
Impact on Referrals to AOD Services Whanganui Demonstration Project showed: increased awareness of AOD referral options Only a marginal increase in referrals at time of interview Referrals received by AOD required a higher level of input consistent with specialist AOD scope of practice Greater consistency of referral content
Impact on Referrals to AOD Services Quality and appropriateness of the referrals improved I ve seen a better quality of referrals by that I mean... by the time someone is referred by the GP what I like is the amount of standard drinks a person is drinking, where they are in terms of readiness for change has been identified it s been a much better process when I first see the client I m able to utilise that information and actually begin the therapeutic intervention rather than mucking round with the screening and collating basic data the client presents with the information whereas before the conversation might have been I ll refer you to AOD but there was no sort of rule. I guess sometimes the patient didn t know what the purpose (of the referral) was. (KI1)
Referral Process E-referrals to DHB AOD Services In process of establishing an E- referral service to Alcohol Drug Helpline
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Maternal & Child Health Services Project Funded by: Health Promotion Agency Area: Northland Timeframe: Jan 2014 April 2015 Objective: Demonstrate how health and social systems can more effectively intervene to improve infant and child mental health, health and social outcomes by reducing the impact of maternal/parental addiction on children Project Focus: Focus on alcohol and other drugs (including tobacco), gambling, domestic violence and depression
Maternal & Child Health Services Project Method: a) Facilitate early intervention in the range of settings where pregnant women and young mothers present (incl. Plunket, Tamariki Ora, primary care, CYF, MSD Children s action plan initiative etc.) b) Better integration between services c) Appropriate level of intervention for pregnant women and mothers of young children
Maternal & Child Health Services Project What will work to improve outcomes for children impacted by parental addiction? Workshop with relevant leaders in health and allied sectors Develop an implementation plan
Maternal & Child Health Services Project Implementation to include: Early assessment and intervention for pregnant women Earlier referral to midwives Early referral to specialist services IT systems to support early assessment and referral Integration and cooperation between services seamless Use of Ruby s Dad