Stafford Borough Council & South Staffordshire LPC ... · violence, relationship breakdown and child abuse. ... , addiction and dependency destroy potential and hope, and have a devastating

SLAJuly2016 Page1of12

StaffordBoroughCouncil&SouthStaffordshireLPC-AlcoholScreening,BriefIntervention,AUDITandFollow-upService

SLA runs from 1st July 2016 SLA between: Service Provider:

Commissioners:

Pharmacies within Stafford Borough

South Staffordshire LPC on behalf of Stafford BoroughCouncil.

Review date April 2017

Valid from 1st July 2016 Valid to 30thJune2017

Background Alcoholmisuse is recognised nationally as being of critical concern in respect of health, including the rise inemergencyadmissions,complexcasesanddelayedtransfersofcare,aswellasalcoholrelatedviolence.Manyareashavedevelopedstrategiesaimedatreducingalcoholrelatedharms,someoftherationalebehindtheseissummarisedbelow.

Unlikeillegaldrugs,alcohol isa legal,freelyavailable,culturallyacceptablesubstance. Individualsoftheirownfreewillcanconsumeasmuchalcoholastheywish,withintheconstraintsofcivilandcriminallaw.

Therearemanypatternsofalcoholconsumptionandsomeformsofharmaremoreassociatedwithparticularproblemsthanothers.Forexample, somechronichealthproblems,suchasalcohol related livercirrhosis,willalmost always be associated with long term heavy drinking. Other acute alcohol related problems, such asviolence,accidentsorvandalismmightresultfromanoccasionalboutofheavydrinking.

Acuteharmsarecommonamongthe largenumberofpeoplewhoregularlybingedrink,yet thesepeoplearenotnecessarilyalcoholdependentanddonotconformtothepopularstereotypeofthealcoholic.

Afocusonindividualdrinkerswillbecombinedwithsupporttothefamiliesandotherscaringforpeoplewithalcohol related harms. Alcohol is a significant factor in a range of domestic problems including domesticviolence,relationshipbreakdownandchildabuse.

“Some alcohol related problems are best addressed at a population level. For example, somebehavioural orhealthproblemsneedtobetackled,atleastinpart,throughtheuseofhealtheducationandotherpreventativecampaigns.Others,suchaspublicdisorder,vandalismandthemanyaccidental injuriesrelatedtoalcohol,arebetteraddressedthroughapproachesinvolvingthecontextinwhichdrinkingtakesplace,suchasmanagementofthelicensedpremisesortheavailabilityofpublictransportlateatnight.

Staffordshire Health and Wellbeing Strategy (SHWBW) 2010-2013 states that alcohol and drugs misuseunderminefamilyandcommunitylife.Theproblemsthatariseoutofmisuse,addictionanddependencydestroypotentialandhope,andhaveadevastatingeffectonthemostvulnerableinoursociety.Jobsandhomescanbelost, friendships and family ties broken and for the children of families where alcohol and drug misuse isprevalentthereisadangerofabandonmentandneglect.

There is a need to work with people and organisations to recognise and realise their potential impact oncommunities.Tosupportindividualsandcommunitiestotakeresponsibilityfortheirownhealthandwellbeing.


AcrosstheStaffordshireeconomy,alcoholrelatedharmisestimatedtocost£322millionperyear.

Public opinion surveys suggest thatmost people think alcohol consumption is a problemand the root of theproblemlies intheEnglishdrinkingcultureandthatmanypeoplearetoowillingtotoleratedrunkennessandantisocialbehaviourasanacceptedpartoflife.Forincreasingnumbersofpeople,gettingdrunkhasbecomethedefinitionof ‘agoodnightout’.Manytake littlepersonal responsibility for theirbehaviour ingettingdrunk inthefirstplace,ortheirsubsequentactionswhendrunk.

SimilarlytootherpartsoftheUK,Staffordshirehasseenanincreaseintheamountofalcoholconsumedbythegeneral public and the subsequent impact of that increase. In Staffordshire there are 131,000 hazardousdrinkers,32,000harmfuldrinkersand21,000alcoholdependentdrinkers.DatafromtheLocalAlcoholProfilesfor England shows that generally alcohol related harm using these measures is greater for males than forfemales.

Across Staffordshire 30% of children aged 11-15 reported drinking alcohol in the week, comparedwith 21%nationally. One in ten young people arrested by police during 2008/09 claimed to have recently consumedalcohol,demonstratingthelinkbetweenunderagedrinkingandcriminalbehaviour.

Itisaprioritytoreducetheharmcausebyalcoholmisuse:bypromotingaresponsibleattitudetodrinking;byreducing the numbers of chronic, binge, hazardous, harmful and dependent drinkers; and by breaking downbarriers,reducingstigmaandhelpingcommunitiestounderstandalcoholmisuse,chronicdrinkingandalcoholdependency.

StaffordBoroughData from the Staffordshire Observatory shows that during recent years, hospital admissions as a result ofincreasedconsumptionofalcoholhave increasedconsiderably. The rateofalcohol specific admissions,whichare those that are conditions wholly related to alcohol, such as alcoholic liver disease and overdose, hasincreasedamongbothmalesandfemalesinStaffordBorough,equatingto323per100,000malepopulationand211 per 100,000 female population. Similarly, alcohol-attributable admissions, which also include conditionsthatarecausedbyalcohol,suchasunintentionalinjuryandstomachcancer,haveincreasedinStaffordBoroughfrom1,237per100,000populationin2006/07to1,709in2010/2011.Hospital admissions for under 18’s was higher for females than for males, and binge drinking estimates forStaffordareamongthehighestinthecountyandhigherthantheestimatesfortheWestMidlandsasawhole.The Stafford Health Profile for 2012 shows that Stafford has approximately 107 per 100,000 alcohol relatedhospitalstaysintheunder18agegroup(significantlyworsethantheaverageforEngland).

Therateofpeopledrinkingat increasingandhigher risk levels inStafford is24%ofadults (individualsage16yearsandover);higherthantheaverageforEngland(althoughnotsignificantlyhigher).

Therewere470alcoholrelatedviolentoffencesduring2011/12(wheretheoffenderisprofiledasbeingundertheinfluenceofalcohol)whichaccountsfor27%ofallviolenceinStaffordBorough4.Whilstthisproportionhasincreased inrecentyears, it isthoughtthatthis is justasnapshotduetothe influenceofalcoholbeingunderrecorded.

Wherealcohol is recorded, it ismainlya factor inviolenceoffences inStaffordTownCentre.Forebridgewardrecorded36%ofallalcohol-relatedviolenceoffencesinStaffordBoroughduring2011/12(170crimes).

Aimsandintendedserviceoutcomes• To improve access to and choice of alcohol screening and intervention support services closer to

peoples’homes.• Toprovidequickeraccesstoearlyassessmentofpotentialalcoholrelatedharm.• Toprovideanearlyinterventiontoreducethenumberofpeoplewhomaybecomealcoholdependent.• Toreducealcoholrelatedillnessesanddeathsbyhelpingpeopletoreduceorgiveupdrinking.• Tohelpserviceusersaccessadditionaltreatmentbyofferingtimelyreferraltospecialistserviceswhere

appropriate.• Tominimise the impact on thewider community by reducing the levels of alcohol related crime and

anti-socialbehaviour,therebyimprovingcommunitysafety.


Servicedescription Community pharmacies within Stafford Borough signed up to the service will deliver coordinated alcoholidentification,screeningandbriefinterventionprogrammeaspartoftheborough-widestrategy.

Theprogrammehas6elements:

1. Identification

Usingdefinedcriteria,clients‘walkingin’toaparticipatingpharmacywillbeofferedscreeningusingtheAUDITalcoholassessmenttool (AlcoholUsageDisorder IdentificationTest,WHO1982). InitialscreeningwilluseNPA“RethinkyourDrink”scratchcards.

DefinedCriteriaforScreening:

AnyclientthatthePharmacist/trainedstaffmemberidentifiesasneedingadvice/supportaroundalcoholuse,butinparticular:

• Vulnerablegroups:- FemalesandMalesand18–30years- BlackandRacialMinoritiesGroups(BRM)allagegroups- 65+malesandfemales- Homeless- Diabetics

• Clientspresentingfrequentlywithsymptomswhichmaybeassociatedwithalcoholmisusee.g.- Gastricproblems–e.g.peptic&duodenalulcers- Fallsandassociatedinjuries- Highbloodpressure- Depression- Anxiety/stress

• IdentifiedduringaMedicationUseReview(MUR),NewMedicinesService(NMS),orSmokingCessation,Emergency Hormonal Contraception (EHC), Chlamydia consultation, or other conversation betweenpharmacistorpharmacyteammembersandpatients/clients/customers.

• Self-referralbytheindividual

• Referralbyanotherhealthorsocialcareworker.People notwishing to initially engage or thosewho choose not to complete the programmemay be offeredappropriatehealthliteratureorreferraltoanalternativeservice.

2. Screening

ThePharmacist / trained staffmemberwillundertakeAUDITwith theclient,having firstexplained the“unit”systemformeasuringalcohol intake. An initial filter,comprisingthefirstthreequestionsofAUDIT(AUDIT-C),willbeused. Thiswillbedelivered in the formofascratch-cardwhichtheclientwillbe invitedtocomplete.Clientsscoring4orlesswillbeexitedfromtheassessmentandprovidedwithprintednotesonthedangersofalcoholandaskedtopasstheseonasappropriate.Forallotherinterviewees,AUDITscoresandaveragetotalnumber of units consumed perweekwill be recorded. The AUDIT score and number of units consumed perweek plus client details should be tracked on a monitoring form. An online monitoring form should becompletedforEACHclientregardlessoftheAUDITscore.Thisscreeningwillbeprovidedfreeofchargeaspartofthenormalpharmacyoperations(Promotinghealthylifestylesessentialservice).

3. BriefIntervention

If the AUDIT score determines that the patient scores between 8 -15 (hazardous drinking category) thePharmacistortrainedstaffmemberwillcarryoutabriefinterventionwhichmustconsistof:

• Explanationofdailybenchmarks• Re-statementofwhatisaunitofalcohol• Explanationofcategoryofdrinker• ExplanationofthecontentoftheEducationalSaferDrinkingInformationleaflet

4. Referral

If a client scores 16 or more (which moves towards either a harmful or dependent drinking category) thenappropriatereferralsshouldbemadetothespecialistservice.Theclientshouldsigntherecordformtoconsenttoreferral.ThepharmacywillthencompletetherelevantreferralformandsendthisdirectlytoOneRecovery


Staffordshire. This referral form is included in Appendix 4 and will be available via the LPC website andPharmOutcomesplatform.

5. Followup

For thoseclientshaving scored8-15 (hazardousdrinkingcategory), thepharmacy shouldattempta followupafter 4 weeks and 8 weeks, using the three follow up questions of the AUDIT-C. The follow-up may beconducted in-pharmacyorbytelephoneanddetailsofresponsestoeachofthesecallswillberecordedusingthePharmOutcomesplatformandtheresultswillbeavailableforviewingin“realtime”.

6. Monitoringoftheservice

Pharmacieswillbeexpectedto:

• Agree to and use screening and data collection tools (AUDIT-C (scratch-card) and AUDIT form.MonitoringviaonlineForminputintoPharmOutcomes)

• Agree to record details about all brief interventions and referral processes on the online recordingsystemPharmOutcomes.Therewillbeonemonitoringentryperclient,andthesewillbesavedsecurelyonthecomputersystemwhichwillbeavailabletoallpharmaciesintheborough.

• Activitydatawillbe recordedonlineonPharmOutcomesand this systemwill generateanyclaims forpayments.ThemoniesandpaymentswillbemanagedbytheLPC.

7. ServicePayment:£5.00 consultation fee paid for every consultation. (i.e. one fee paid for each interaction at Stage 1 - BriefAdvice,atStage2–FirstFollowUp(Week4)andatStage3–SecondFollowUp(Week8).PaymentbyBACStopharmacynominatedbankaccount QualityIndicators

• Thepharmacyhasappropriatehealthpromotionmaterialavailablefortheusergroupandpromotesitsuptake.

• Thepharmacyreviewsitsstandardoperatingproceduresandthereferralpathwaysfortheserviceonanannualbasis.

• ThepharmacycandemonstratethatpharmacistsandstaffinvolvedintheprovisionoftheservicehaveundertakenCPDrelevanttothisservice.

• Thepharmacyparticipatesinanyorganisedauditofserviceprovision.

• Thepharmacyco-operateswithanylocallyagreedassessmentofserviceuserexperience.

MeasurableOutcomes

• Numberof“RethinkyourDrink”Scratchcardsissued

• NumberofFullAUDITassessmentsundertaken,scoresrecordedandoutcomes

• NumberofDrinkersscoring8-15onfullAUDITrecorded

• Numberoffollow-upinterventionsundertakenonthosescoring8-15onfullAUDIT

• Numberofpeoplescoring16oraboveonfullAUDITreferredtospecialistserviceAdditionalInformation(notformingpartoftheservicespecification)

CPPEtrainingwhichmaysupportthisservice:www.cppe.ac.uk

OpenLearning:AlcoholMisuse:SupportandAdvicefromthePharmacyTeamOthertrainingandresources:

SouthStaffordshireLPCwebsite–www.southstaffslpc.co.uk

AlcoholLearningCentre-www.alcohollearningcentre.org.uk

AlcoholAcademy–www.alcoholacademy.net

DrinkAware–www.drinkaware.co.uk

RethinkyouDrink–www.rethink-your-drink.co.uk


AcceptanceofSLA–1formrequiredpercommunitypharmacypremises:

PleasenotethatSouthStaffordshireLPC/StaffordBoroughCouncilhavetherighttowithdrawthisServiceLevelAgreement at any time, or if the requirements are not being met, giving four weeks written notice. If thePharmacywishestowithdrawfromthescheme,fourweekswrittennoticeisrequired.

ForandonbehalfoftheCommunityPharmacy: For and on behalf of South Staffordshire LPC andStaffordBoroughCouncil:

Signature:

Signature:

NameofSignatory: NameofSignatory:

Position: Position:

DateofSigning: DateofSigning:

AsignedcopyofthisagreementwillbekeptbythePharmacyandSouthStaffordshireLPConbehalfofStaffordBoroughCouncil.

Pleasealsocompletethefollowingdetails:Pharmacyname

PharmacyOCScode(PPAcode)

PharmacyStamp

Pharmacyaddress

Phonenumber

Faxnumber

ContactName

Emailaddress


STAFFORDALCOHOLSERVICE-AUDIT-CSCORERECORDAppendix1

Pharmacy SheetNumber:stamp:

CLIENTNo. GENDER(M/F) POSTCODE(1STHALF) AGE AUDIT-CSCORE

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30


Appendix2 :

Stafford Alcohol Identification and Brief Advice Service Stage 1 – Full AUDIT result and intervention for clients scoring 5 or more on the scratch card. Date PatientName

DOB Postcode

Gender Personcompletingintervention

Medical Information: Is your health? Excellent Good

Average Poor Do you suffer from? Diabetes Gastricproblem(egpeptic+/or

duodenalulcer Fallsandassociatedinjuries

Highbloodpressure Depression Stress/Anxiety

Other;pleasegivedetailsifappropriate…

Are you pregnant? Yes No MaleN/A

AUDIT SCORES

AUDIT-Cscore(scratchcard)(maxscore12)

AUDITpart2score(maxscore28)

Full AUDIT score(maxscore40)

Interventions Infoleafletgiven Advicegiven ReferredtoOneRecovery

Referredbutdeclined Other NoAction

Declarations and Consent ShareinfowithOneRecovery? Phonecontactacceptable?

PhoneNumber Dateforfollowup Stage2–Firstfollowup(week4)

Date PatientName

AUDIT-Cscore(max12) Personcompletingintervention



Stage3–Secondfollowup(week4)Date PatientName

AUDIT-Cscore(max12) Personcompletingintervention




Appendix 3

This is one unit of alcohol…

…and each of these is more than one unit

AUDIT – C

Questions Scoring system Your

score 0 1 2 3 4

How often do you have a drink containing alcohol?

Never Monthly or less

2 - 4 times per month

2 - 3 times per week

4+ times per week

How many units of alcohol do you drink on a typical day when you are drinking?

1 -2 3 - 4 5 - 6 7 - 9 10+

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

Never Less than

monthly Monthly Weekly

Daily or

almost daily

Scoring: A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive.

Score from AUDIT- C (other side)

SCORE

SCORE


Remaining AUDIT questions

Questions Scoring system Your

score 0 1 2 3 4

How often during the last year have you found that you were not able to stop drinking once you had started?

Never Less than


Daily or

almost daily

How often during the last year have you failed to do what was normally expected from you because of your drinking?

Never Less than


Daily or

almost daily

How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?

Never Less than


Daily or

almost daily

How often during the last year have you had a feeling of guilt or remorse after drinking?

Never Less than


Daily or

almost daily

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

Never Less than


Daily or

almost daily

Have you or somebody else been injured as a result of your drinking?

No

Yes, but not in the last year

Yes, during the

last year

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?

No

Yes, but not in the last year

Yes, during the

last year

Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence

TOTAL Score equals AUDIT C Score (above) +

Score of remaining questions

TOTAL

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REQUEST FOR ONE RECOVERY ASSESSMENT

REFERRAL FORM

*PLEASE COMPLETE ALL SECTIONS – FAILURE TO DO SO MAY MEAN IT CANNOT BE PROCESSED* ** ONCE COMPLETED PLEASE SEND BACK TO YOUR LOCAL SERVICE. ADDRESSES CAN BE FOUND ON THE LAST PAGE **

Referral Date: ______________ Name of Referring Professional: _____________________________________________ Referring Agency:______________________________________________ Contact №: _____________________________ Agency Address: ______________________________________________________________________________________

Client Details

Forename: Surname: _______________________________________ ________________________________________ D.o.B. _________________ Gender: ___________ Ethnicity: __________________ NHS №: ________________________ Address: __________________________________________________________________________________________ ___ __________________________________________________________________ Post Code: ________ ______________ Tel №: Second contact №: ___________________________________________ _________________________________ GP name & address: ___________________________________________________________________________________ Other services currently involved & keyworker (1): ___________________________________________________________ Other services currently involved & keyworker (2): ___________________________________________________________ Any known literacy problems? ___________________________________________________________________________ Preferred method of contact? (phone or letter) ____________________________________________________________

Drug/Alcohol Information

Reason for referral Alcohol Use: Other Drug: (please specify)

_________________________ Opiate Use:

Current Drug Use Current use of illicit substances. Please circle YES or No. If yes, state amount used and route of use

Appendix 4

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Amount Route 1. Opiates Yes or No 2. Cocaine Yes or No 3. Benzodiazepines Yes or No 4. Cannabis Yes or No 5. Other(s) Yes or No

Current alcohol use Current amount of alcohol/week. Please state number of units and type of drink

Alcohol dependence symptoms present: YES

NO

AUDITS

Current PRESCRIBED medication - circle YES or NO (If more drugs please use extra sheets of paper)

Please identify any risks/details with reference to: Pregnancy

Domestic violence

Physical health

Mental health

Disability

IV drug use

Other

Identified Risks Please identify any other relevant details

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Stafford Borough Council & South Staffordshire LPC ... · violence, relationship breakdown and child abuse. ... , addiction and dependency destroy potential and hope, and have a devastating

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