Exploring the management of alcohol problems in Deep End practices in Scotland

Andrea Mohan (Lead / Corresponding author), Danielle Mitchell, Clare Sharp, Niamh Fitzgerald, Douglas Eadie

Research output: Book/ReportCommissioned report

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Abstract

Alcohol causes significant harm to the health of the population in Scotland, and especially among those living in the most deprived areas. Increases in alcohol consumption among certain groups of the population during the COVID-19 pandemic may further escalate alcohol harms. There are issues within the current system of alcohol treatment and services (both in primary care and specialist alcohol services) which make it difficult to cater for the needs of all individuals with alcohol problems. In 2019, the Primary Care Alcohol Nurse Outreach Service (PCANOS) (piloted initially as the Attached Alcohol Nurse in 2015/16) was implemented in selected Deep End GP practices (those that service the 100 most deprived communities across Scotland) in Glasgow. This involved specialist addiction nurses working closely with GP practices to help engage and provide care for patients with alcohol problems who had not previously engaged or had not engaged well with community alcohol services, and to eventually link patients to mainstream services upon discharge.

This report presents the findings of a qualitative study to gather stakeholders’ experiences and perspectives on PCANOS and the wider community alcohol services. The study involved interviews with 18 professionals (including PCANOS Addiction Nurses, GPs, Link Workers, Practice Managers and strategic staff) and seven patients.

Key findings:
PCANOS provided a novel and practical approach to managing alcohol problems in primary care, specifically for people with moderate to several alcohol problems who had low engagement with other alcohol services.
• PCANOS was perceived as a person-centred approach that helped to address the needs of individual patients – it was felt to have had a positive impact on patients’ drinking behaviour and health and wellbeing. Key aspects related to this included that PCANOS offers a flexible service, facilitates a good therapeutic relationship between the nurse and patient, is supportive and motivational for patients and that the PCANOS nurses can draw on a wide range of skills when helping patients address their alcohol problems.
• Collaborative working between staff in GP practices was enabled by having the PCANOS Addiction Nurses working in close proximity with the practice – this facilitated the referrals process and allowed information about patients and expertise among different practice staff to be more effectively shared, helping to address multiple patient needs.
• Collaborative working helped to generate a more coordinated approach to patient care – PCANOS Addiction Nurses discussed care plans with staff across primary care, the hospital sector and mainstream community services, helping patients to make a quicker and smoother transition between different services.
• Support from GP practices was viewed as essential in facilitating the implementation of the PCANOS service – GPs’ awareness of the service and referrals to the service were important to ensuring that the correct patients received support for managing their alcohol problems.
• Some barriers and challenges to implementing the service included a reluctance among some GPs or practices to engage with the service and a lack of awareness of the service among some GPs. There were also challenges relating to working with a stigmatised patient group who may be reluctant to discuss their drinking and have complex needs, requiring sufficient time to build up a relationship with patients.
• Compared with treatment and support provided through PCANOS, other alcohol services were thought to be less person-centred – experiences of other alcohol services were that there was limited time to focus on engaging patients and limited flexibility in when patients can be seen. GPs also reported that the communication between them and other alcohol services was not as good as the communication they had with PCANOS.

Recommendations:
• Provide long-term funding for PCANOS to enable the continued support of people with alcohol problems who have complex needs.
• Conduct more research to establish an evidence base on the effectiveness of unique services such as PCANOS, in supporting people with moderate to severe alcohol problems who do not engage with alcohol services.
• Conduct research to look at impact of COVID on alcohol services in primary care.

Original languageEnglish
PublisherScottish Health Action on Alcohol Problems
Commissioning bodyScottish Health Action on Alcohol Problems
Publication statusPublished - Mar 2022

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