Time for carefully tailored set of alcohol policies to reduce health-care burden and mitigate potential unintended consequences?

Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment

Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, "Alcohol Prevention in Urgent and Emergency Care" (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative-participatory design approaches and a rigorous six-step ASPIRE methodology (involving n = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey (n = 18) and then participated in individual qualitative interviews (n = 15). Analysis of data was aligned with Levels 1-3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers' perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement.

The behaviour of alcohol-dependent drinkers of spirits during level 4 COVID-19 lockdown in Auckland, New Zealand

Introduction

Behaviour of alcohol drinkers during previous major public health or economic crises has varied, with reductions in use generally occurring during periods of reduced availability. This study aimed to discover the behaviour of a group of dependent drinkers of spirits during a 33‐day period of complete closure of physical stores selling spirits during COVID‐19 lockdown in Auckland, New Zealand, March 2020.

Methods

Electronic clinical records of drinkers waitlisted to complete an alcohol detox at the in‐patient service were followed from day 1 of lockdown and outcomes at the end of the period analysed.

Results

Drinkers of spirits were statistically more successful in stopping drinking (P = 0.002) than those of wine or beer. Only 26% chose to switch to an alternate alcohol type initially.

Discussion and Conclusion

A sudden reduction in availability of spirits resulted in positive behaviour change in spirits drinkers compared to those of other alcohol types, aided by the support of detox services. Internet alcohol purchasing, while not used by this group, deserves close future scrutiny due to its potential to increase alcohol availability in dependent drinkers.