A clinical trial funded by Pharmacy Research UK has shown no beneficial effect of a brief alcohol intervention delivered by community pharmacists in reducing hazardous or harmful alcohol consumption. Alcohol intake has become a major public health challenge in the UK, driven by the complex relationships between consumption and overall health and social outcomes. Harmful drinking is identified as a pattern of alcohol consumption that is causing mental or physical damage whereas hazardous drinking refers to an increase in risk of harm from alcohol consumption.
Although the evidence base for brief interventions to reduce alcohol consumption is strong in primary care, there is less robust evidence for community pharmacy involvement. Community pharmacists have good access within different communities and are well positioned to assist with alcohol supports. In this instance researchers from King’s College London, Durham University and the University of York conducted a randomised controlled trial assessing the efficacy of a brief motivational discussion of approximately 10 minutes versus a leaflet-only approach in 16 community pharmacies in London. The results indicate no beneficial effect in reducing hazardous or harmful alcohol consumption using motivational discussion.
“The brief intervention delivered by community pharmacists for this trial appeared to have no effect in reducing hazardous or harmful alcohol consumption.
Continuing to implement alcohol brief intervention across pharmacies without evidence of its effectiveness in reducing risky alcohol use or an understanding of the particular features of the service which are required for a successful intervention is not recommended.
However community pharmacy remains a promising setting to deliver alcohol brief intervention, future research could consider redesigning the alcohol brief intervention content for a larger-scale study. This could include extending and intensifying the training for pharmacy staff to help prepare community pharmacists to more effectively deliver alcohol brief intervention, as well as identify alternative means of targeting pharmacy customers for whom alcohol brief intervention could be effective.”
– Ranjita Dhital, ‘Institute of Psychiatry, Psychology & Neuroscience’ King’s College London
Dr Rachel Joynes, Head of Research and Evaluation at the Royal Pharmaceutical Society (RPS) comments “We’ve seen evidence that screening for alcohol misuse in this setting is feasible but further larger scale studies are still needed to define effective interventions and approaches that pharmacist can integrate into their everyday practise. Studies like this highlight the potential of harnessing community pharmacies for research but in the case of alcohol misuse research also needs to be undertaken to investigate the patient side of the picture in terms of acceptability of interventions for users.”
For more information about involving communities pharmacies in research see the RPS ResearchReady programme.
More information about the results of the project can be found below and here.
This thesis aimed to address the knowledge gap of the delivery of alcohol brief intervention (BI) from community pharmacies. The research aimed to design and implement an alcohol BI in community pharmacy delivered by pharmacists, and to assess its effectiveness to reduce harmful and hazardous drinking of pharmacy customers. The programme of work, reported in this thesis, comprise four related studies conducted within the first three phases of the Medical Research Council’s (MRC) framework for developing and evaluating complex healthcare interventions.
The four studies comprised of: i) purposive sampling survey of pharmacy customers’ views of a potential alcohol BI delivered by community pharmacists to determine service utilisation; ii) assessment of pharmacists’ attitudes, knowledge and views to delivering alcohol BI and to determine if these variables were related to alcohol BI delivery; iii) focus group study to identify range of barriers and enablers experienced by low-, moderate- and high-activity pharmacists to alcohol BI delivery; iv) apply findings from subsequent phases of the study to design and deliver the first known randomised controlled trial to assess the effectiveness of pharmacy alcohol BI.
Pharmacy customers were positive about participating in alcohol BI. Pharmacist motivation evaluated using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), and role adequacy and work satisfaction improved among ‘active’ pharmacists. Training and support were identified as important factors influencing service delivery. At three months 326 (80% overall; 82% intervention, 78% control) participants were followed up. The difference in reduction in total Alcohol Use Disorder Identification Test (AUDIT) score (intervention minus control) was -0.57 95% CI -1.59 to 0.45, p = 0.28.
A brief intervention delivered by community pharmacists appeared to have no effect in reducing hazardous or harmful alcohol consumption. Community pharmacy remains a promising setting to deliver alcohol BI, future studies could consider redesigning the alcohol BI content for a larger-scale study, extending training for pharmacy staff, and identify alternative means of targeting pharmacy customers for whom alcohol BI could be effective.
- Dhital, R., Norman, I., Whittlesea, C., Murrells, T. & McCambridge, J. (2015)
The effectiveness of brief alcohol interventions delivered by community pharmacists: randomised controlled trial. Addiction (accepted for publication), doi: 10.1111/add.12994.