Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study

Background Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. Methods A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Results Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs’ beliefs about patient-centred practice. Conclusions Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs’ provide care

A survey of paramedics and alcohol related work: ascertaining fear of, and level of assault amongst the North East Ambulance Service

For North East Ambulance Service NHS Foundation Trust (NEAS) employees, contact with patients with alcohol related injury or illness is increasing, along with a general increase in workload. The aim of this survey was to ascertain the fear of, and actual levels of assault amongst NEAS employees, and to identify workload pressures arising from patient alcohol consumption. Basic procedures The survey, undertaken in 2014, looked at ‘risky locations’, frequency of physical and sexual assault, and workload pressures from alcohol related incidents. Main findings Thirty two per cent of NEAS frontline staff (n=358), completed the survey. The majority of callouts perceived to be alcohol related were at weekend nights. Ninety three percent of participants reported that they have experienced a threat of violence (n=332), with 47% of participants (n=168) having been assaulted by a (perceived) intoxicated member of the public, and 45% having endured some form of sexual assault or harassment (n=147). Additionally, 72% (n=244) reported feeling most at risk in private residences. The majority of participants (76%) did not feel they had received adequate training to deal with alcohol related incidences. Principal conclusions NEAS employees experience high levels of assault and fear of assault and current training needs to be revisited, especially around prevention and management of sexual assaults/harassment

Population level effects of a mass media alcohol and breast cancer campaign:A Cross-Sectional Pre-Intervention and Post-Intervention Evaluation

Aims This study aims to examine the relationship between a TV-led breast cancer mass-media campaign (conducted in two waves: Jul/2015 and Nov/2015), awareness of the link between alcohol and cancer, intention to reduce alcohol consumption and support for alcohol policies. Methods Three cross-sectional surveys were conducted; one over the two weeks pre-campaign (n=572); one immediately following campaign wave 1 (n=576); and another immediately following campaign wave 2 (n=552). Survey questions assessed; campaign exposure; awareness of the links between alcohol and related cancers; intention to change alcohol consumption; and support for alcohol related policies. Results The proportion of respondents indicating awareness of alcohol as a cancer risk factor was significantly larger post-campaign compared to pre-campaign. The largest increase was seen for breast cancer with 45% aware of the links post-campaign wave 2 compared to 33% pre-campaign. The proportion of respondents indicating ‘strong support’ of the seven alcohol related policies significantly increased between surveys. The proportion of respondents both aware of alcohol as a cancer risk factor and supportive of the seven alcohol related policies significantly increased between surveys. There was no significant change in self-reported intention to reduce alcohol consumption amongst increasing/higher risk drinkers. Conclusion These findings indicate that a mass-media campaign raising awareness of the links between alcohol and breast cancer is associated with increased awareness and policy support at a population level. Whilst a campaign in isolation may not be effective in changing individual drinking behaviour, it may be associated with increased public support for alcohol public health policy. Summary A mass-media campaign raising awareness of the links between alcohol and breast cancer is associated with increased awareness and alcohol policy support at a population level but does not appear to be effective in reducing drinking intentions

Pooling local public health budgets to achieve exceptional value for money: the case of the North East of England

Background and challenges to implementation The North East of England (pop 2.6m) has significant health challenges, largely resulting from an historic industrial past, and subsequent high rates of tobacco use. The region united in pooling public health budgets in order to deliver key interventions at scale. Eight key strands of tobacco control have been delivered synergistically over the last decade including smoking cessation, advocacy and media, regulation, research, secondhand smoke protection. Intervention or response The overall annual budget of USD 915k is used cost-effectively and funds a small regional multidisciplinary team supporting the work of the localities providing expertise, strategic support, advocacy, mass media campaigns, coordinating practice sharing and industrializing system wide reform, and delivering work at scale on complex issues. The work is guided by international best practise and informed by national tobacco strategies including those from ASH UK, Department of Health and Public Health England. Results and lessons learnt There has been a 41% reduction in the smoker population - the biggest regional decline in the last decade. A social movement has grown with high levels of public support for future regulation. Making tobacco control 'everyone's business' has been important and having a clear vision for the future vital to maintain funding commitment and focus. It is important to constantly reinforce the rationale for this investment from a health inequalities perspective and the strong return on investment tobacco control gives. Conclusions and key recommendations Significant economies of scale have been achieved with high value for money. In the UK there is a need for effective tobacco action from the community grass roots level right up to the national and international stage. A similar approach is in place around alcohol denormalisation now through the regional programme "Balance" and the two programmes are working together with notable success.The North East England provides a useful model for others

Additional file 1: of Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study

Interview guide for General Practitioners. (DOCX 19 kb

Proceedings of the 14th annual conference of INEBRIA: New York, NY, USA, September 14–15, 2017

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