An innovative approach to monitoring the health risk of alcohol use for patients was outlined at the Royal New Zealand College of General Practitioners (RNZCGP) conference in Christchurch today (Friday September 3).
Providing systematic screening and intervention in alcohol risk and problem drinking has been difficult to sustain in general practice due to competing demands on time and lack of supportive primary care structures.
However, Whanganui Regional PHO GP Dr John McMenamin has developed a computer programme which makes screening for alcohol problems and the provision of follow-up support easier within a primary mental health context.
Dr McMenamin has modelled the computer software on similar programmes dealing with stopping smoking. The screening tool uses an ABC approach – ask about smoking, provide brief intervention, offer cessation support.
“The success of the ABC approach for smoking in Whanganui has led to the development of this project, ABC Alcohol,” Dr McMenamin says. In the alcohol programme, ABC stands for ask about alcohol, offer brief intervention, and refer people at highest risk for counselling.
Dr McMenamin has been working with the Alcohol Advisory Council of New Zealand (known as ALAC) to develop the programme. The software basically raises a flag on a patient’s record if they have not been questioned about their alcohol use. Initially the patient is asked three questions about their frequency of alcohol consumption, the amount they consume per drinking session, and how often they have more than six drinks at any one time.
If the patient’s answers to the initial three questions indicate consumption above ALAC’s nationally accepted guidelines for risky drinking, the programme automatically opens a further questionnaire known as the alcohol use disorder identification test (AUDIT). This scores the patient according to their risk of harm from excessive drinking.
People whose drinking is placing them at risk would receive brief intervention in the form of individually tailored education. People with alcohol dependency would be referred to an alcohol specialist nurse or specialist alcohol counsellor for support.
“There is nothing new about the practice nurses and GPs asking people about alcohol,” Dr McMenamin says. “What is different about the programme we are offering here is that it is a structured approach with software which asks the questions and records the information. It is a planned support package within the practice with an identified nurse trained to be able to manage the problems that are identified and a backup specialist counsellor at primary care level.”
“If this programme is successful in our practices, then what we have is a process we know can be made available to other practices within New Zealand at reasonably low cost which could enhance the detection and identification of alcohol problems amongst our patients.”
The pilot started in February 2010 and was pre-tested in two practices – Wicksteed Medical Centre which has five GPs and Aramoho Health Centre which has seven GPs, and subsequently expanded to all 35 practices in Whanganui Regional PHO. It is hoped a successful Whanganui pilot will mean the programme can become available to practices nationwide.
“This gives us an easy tool and an easy structure to use to be able to identify people in regard to their alcohol use in a way that fits comfortably and easily into general practice,” Dr McMenamin says.