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Patient leaflet enough to tackle problem drinking, researchers suggest

GPs should give patients with problem drinking a leaflet rather than advise them to reduce their alcohol intake, finds a new study being considered by QOF advisors.

The SIPS study found informing patients of their drinking levels and offering a leaflet – handed to patients by a practice nurse – was just as effective as giving patients five- or 10- minutes of lifestyle counselling.

The study is currently being looked at by NICE as a model for a planned future indicator linked to screening and intervening in patients consuming too much alcohol.

This new research in GP practices suggests that giving patients the results of their screening and a leaflet may be the most effective approach, rather than more intensive methods.

The findings, published in the BMJ this week, were from a prospective trial involving 756 patients recruited in primary care practices in the north east and south east of England and in London.

They looked at the impact of three different interventions for patients who are identified as having harmful drinking levels using the AUDIT screening tool: patient feedback and an information leaflet, five minutes of structured brief advice or 20 minutes of lifestyle counselling.

When followed up after six months and 12 months, there was no significant difference in hazardous or harmful drinking status between patients assigned to any of the three interventions delivered by either GPs or practice nurses.

At six months, 36% of patients given feedback and a leaflet had non-harmful drinking levels, compared to 29% of patients who received five minutes of brief advice and 29% of patients who received 20 minutes of lifestyle counselling. At 12 months, the levels of non-harmful drinking for these groups were 39%, 35% and 36% respectively.

Dr Steve Brinksman, a GP in Birmingham and clinical director for the Substance Misuse Management in General Practice Group said the study supported rolling out targeted interventions in patients with alcohol problems, but he disagreed that a leaflet was all that was needed.

He said: ‘When you identify someone with an alcohol problem you have got to make an effort identify what level of problem they have. There will be some people who have mild or moderate dependency, other people whose drinking is quite harmful and it might be affecting their blood pressure. You’ve got to assess those things, you can’t just say “Oh, that sounds like too much alcohol, here’s a leaflet’,” he said.

‘We routinely ask somebody who presents with high blood pressure if they smoke and yet we don’t routinely ask them how much they drink, and that’s a bit bizarre.’