Health Equity Audit Alcohol
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Health Equity Audit Alcohol

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Health Equity Audit Alcohol Treatment Health Equity Audits (HEA)(1) can be used to help identify how fairly services or resources are distributed in relation to the health needs of different groups across a community. This can include both resources such as income and facilities in addition to the determinants of health such as employment and education. The overall aim of a HEA is to distribute resources in relation to need. Any changes in investment and services which may occur as a result of HEAs will reduce health inequalities and promote equal opportunity to services and facilities. Effective use of HEAs should involve a wide range of agencies, both public and private, to ensure an extensive input into the process.(1)(2) Local strategic partnerships (LSPs), which include police, local authority, NHS, community and voluntary sector, provide a role in overseeing local action to tackle the determinants of health inequalities in the community. An HEA provides one such mechanism for tackling inequalities and is used here to begin to address the issue of alcohol misuse. There are six steps involved in a health equity audit, which is illustrated below. (1) 1. Agree partners and issues 2. 6. Review Equity progress profile: & assess identify impact the gap 5. Secure 3. Agree high changes in impact local investment action ...

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Health Equity Audit Alcohol Treatment Health Equity Audits (HEA)(1) can be used to help identify how fairly services or resources are distributed in relation to the health needs of different groups across a community. This can include both resources such as income and facilities in addition to the determinants of health such as employment and education. The overall aim of a HEA is to distribute resources in relation to need. Any changes in investment and services which may occur as a result of HEAs will reduce health inequalities and promote equal opportunity to services and facilities. Effective use of HEAs should involve a wide range of agencies, both public and private, to ensure an extensive input into the process.(1)(2) Local strategic partnerships (LSPs), which include police, local authority, NHS, community and voluntary sector, provide a role in overseeing local action to tackle the determinants of health inequalities in the community. An HEA provides one such mechanism for tackling inequalities and is used here to begin to address the issue of alcohol misuse. There are six steps involved in a health equity audit, which is illustrated below. (1)
6. Review pr & im
5. Secure changes investme & local delivery
1. Agree partners and issues
              
4. Agree priorities for action
2. Equity rofile: entify he gap
ree high ct local n to narrow the gap
Step 1: Agree partners and issues Alcohol plays an important role in both our society and economy. However, where it is misused alcohol is also a major contributor to a range of harms, at considerable cost. These harms include: harms to the health of individuals; crime, anti-social behaviour, domestic violence, and drink-driving and its impact on victims; loss of productivity and profitability; social harms, including problems within families.(3)Alcohol misuse and rehabilitation is one of many issues facing Teignbridge. The partners that will be working together include Teignbridge PCT, GP practices, police, local authority and other interested parties. It is important to recognise the need to involve as many organisations as is feasible in decisions of this type and there is likely to be a requirement for licensees to be involved to promote sensible drinking messages. Step 2: Identify the Gap Graph 1 shows that number of alcohol related deaths has doubled since 1993; this is a cause for concern as it shows a clear upward trend, both locally and nationally, and looks set to rise further. Due to the small numbers of alcohol related deaths it has been necessary to combine data from Plymouth, South Hams, Teignbridge and Torbay. Graph 1: Deaths across Plymouth, South Hams, Teignbridge and Torbay directly attributable to alcohol misuse. (4)
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Graph 2 shows the number of hospital admissions that are related to alcohol misuse and also shows a clear increasing trend for all age groups especially in the age groups 45 and over.
Graph 2 Teignbridge PCT Admissions to Hospital where the Primary Diagnosis is related to Alcohol Misuse. (5)
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Graph 3 Male Admissions to Hospital where Primary Diagnosis is related to Alcohol Misuse. (5)
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Overall there appears to be an upward trend in both the female and male admissions to hospital, with the female admissions showing a clearer up ward trend.
Graph 4 FemaleAdmissions to Hospital where Primary Diagnosis is related to Alcohol Misuse. (5)
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There is currently a very limited statutory alcohol service in the Teignbridge area. There is a statutory service in Torquay, the South Devon Community Drug & Alcohol Service based at Shrublands House. A non-statutory service is based in Exeter but they are unable to treat Teignbridge residents due to pressure on services from their locality. Alcohol Anonymous (AA) and Al-Anon are available locally as is national helpline Drinkwise. Local facts and figures relating to alcohol: (6) Alcohol hospital admissions in the Teignbridge area have increased from 183 in 2001/02 to 230 in 2003/04. In February 2005 the South Devon Drug and Alcohol Team had 195 people from Teignbridge on its waiting list of which, 38 were classed as priority 1, 23 were priority 2 and 134 were priority 3. The South Devon Drug and Alcohol Team defines those in priority 1 as having a very high dependance on alcohol, priority 2 as people who tend to binge drink and priority 3 as those who are non-dependant alcohol consumers.(7) National data indicates that around 35% of domestic violence incidents are fuelled by alcohol. Data from 2002 indicated that across Teignbridge there would be an expected 220 domestic violence incidents per year, which are related to alcohol. Across Devon there were 1409 incidents of alcohol related crime between April and August 2002. In 2003 this figure was lower at 1295.(8)
In 2001 there were 587 casualties (5 fatalities) from road accidents across Teignbridge, of which 30 would be expected to involve illegal levels of alcohol and many more to involve lesser amounts of alcohol. In those over 65 17% of men and 7% of women exceeded the sensible limits of consumption. This is of concern since the national guidance on safe drinking are based on the drinking patterns for the young, and the elderly may be more physiologically susceptible to drink. Step 3: Agree high impact local action to narrow the Gap This stage is fundamental to the success of the equity audit process. It involves a review of local interventions and services and to examine which initiatives are likely to make the most difference in reducing the health inequity given the local population characteristics. (2) The new GMS2 enhanced alcohol service (6) offers scope for introducing alcohol referral services within a primary care setting. The provision of such services is key to ensuring that those individuals are offered help and advice at an early stage and should be prioritised as a key method for reducing alcohol problems. This service could involve a single practice providing a service or a number of practices providing a joint service. Such a service could provide an intermediate type referral system which whereby patients who show type a certain level of symptoms are treated, with those patients with a greater number of symptoms being referred to specialist alcohol services, such as Shrublands, who have more experience dealing with alcohol dependency. Funding of this type of service could allow a specialist nurse, psychiatrist and/or social worker to be employed across those practices involved. There is a growing amount of literature which reinforces the links between alcohol and crime. These references include alcohol specific offences, such as drink driving and drunkenness, to alcohol related violence and domestic violence. Work by Purser identifies a number of the links between alcohol and crime: It can cause the crime to be committed (in the case of drink driving or drunkenness offences). It can be linked to crimes against licensing laws (e.g. selling to, or serving people under age or serving people who are intoxicated). It can be a disinhibitor (e.g. where it is used for courage during an offence). It can be linked to crimes committed because of an alcohol problem (e.g. to obtain money for alcohol). It can be presented in mitigation as an explanation for criminal behaviour. (6) Across Teignbridge PCT and LA the proportion of residents over 65 is much greater than that across the UK as a whole with around 25% of Teignbridge residents being over 65, see graph 5. There are particular problems in treating alcohol problems in older people with alcohol misuse often being mistaken for general signs of ageing. The current elderly population are much higher drinkers than past generations and a greater proportion than in other age groups are likely to drink daily.
A particular cause for concern in this age group is that many elderly people live on their own and any issues around alcohol misuse may go unnoticed. On a typical day in the NHS as many as 1 million people visit their GP (9) with elderly people visiting their GP much more frequently than the average person with many also having home visits during the course of a year. Graph 2 shows the number of admissions to hospital and highlights the high level of admissions amongst the older populations. Given the frequent visits many elderly people are likely to have to their GP there are considerable opportunities for opportunistic screening around alcohol misuse which may allow treatment and interventions to be accessed early and to prevent hospital admissions occurring later on. An alcohol service in GP practices would bring considerable benefits. It would allow easy access for all age ranges, in particular access for older people who have more regular visits to GPs, whilst allowing young people access if required. It also provides more discreet location than the alternative location Shrublands which is associated with both drug and alcohol dependent patients. Such a location may encourage patients with an alcohol misuse problem to come forward for treatment which is less likely to be the case if they are referred to a specialist drug and alcohol service. Graph 5: Population figure for Teignbridge PCT 2003/04. (4)
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Step 4: Agree priorities for action Setting targets to reduce health inequities is a partnership decision between commissioners, providers and users of services. Targets are best seen as a tool to ensure that resources and effort are directed at tackling health inequities in an explicit and measurable way.
The new GP contract provides an opportunity to develop an enhanced service to tackle the problems of alcohol misuse. This service is designed to cover the enhanced aspects of clinical care of the patient all of which are beyond the scope of the essential services. The aim of this service is to improve the quality of care provided by practice to patients who misuse alcohol. The service will achieve this by incentivising and training GPs to advise and treat alcohol misusing patients, and undertaking more specialised treatment of alcohol dependant patients. The overall aim of the enhanced alcohol service should not be to reduce consumption of alcohol for everybody, but should be to reduce the harmful effects of excessive drinking. Alcohol in moderation can improve some health conditions and may benefit an individuals quality of life. It is only those individuals with harmful drinking patterns whose behaviour is of cause for concern and these individuals should be prioritised within the strategy. Step 5: Secure changes in investment & service delivery The aim of the enhanced service is to improve the quality of care provided by practices to patients who misuse alcohol. This can be achieved by giving incentives and training GPs to advise and treat patients who are alcohol misusers. Also the service will provide more specialised treatment of alcohol dependant patients. Enhanced service outline: (10) 1.The development and production of an up-to-date register.Practices should be able to produce an up-to-date register of all patients who admit they are alcohol misusers. This register will be used as an audit tool 2.Practices to be able to undertake brief interventionsand offer support to carry out behavioural change. 3.Follow-up treatment.A range of treatments may be prescribed including a set number of counselling sessions which may be done in conjunction with or by referral to local alcohol services or through the patients attendance at a day programme or residential rehabilitation centre, both of which would require referral. 4.Detoxification regime.For those where a detoxification regime is required, this may be provided by the primary care team (and could be undertaken in partnership with alcohol support services) in the community or home setting. 5.Routine use of assessment tools. 6.Liaison with local specialist alcohol treatment services. 7.Appropriate training.This must be available to the primary care team to enable team members to understand the problems experienced by people who misuse alcohol and their families, and to communicate effectively with them. Training should include
detecting problem drinkers, carrying out brief interventions, and managing follow-up treatment, including counselling. 8.Review.All practices involved in the scheme should perform an annual review which could include an audit of: (a) Those identified and recorded as alcohol misuse patients. (b) The advice and/or treatment offered to patients who, following screening have been shown to misuse alcohol. (c) The number of patients who have reduced their alcohol consumption. (d) Feedback from patients who misuse alcohol and their families.Step 6: Review progress & assess impact This step is the review process it will look at whether or not the health equity audit is reducing the inequities faced by its target population. It will be used to find out if the new enhanced service is being used and how successful it has been at achieving its targets. Reference: 1.Department of Health, Health Equity Audit a Guide for the NHS. 2.Health Equity Audit Made Simple: A briefing for Primary Care Trusts and Local Strategic Partnerships. 3.Alcohol Harm Reduction Strategy for England (2004) 4.South Devon Health informatics service BOD population table. 5.South Devon Health informatics service BOD NWCS. 6.Tackling Alcohol Misuse across Teignbridge. 7.Shrublands, South Devon Drug and Alcohol team, Alcohol proposal Feb 05. 8.Devon and Cornwall Police. 9.Department of Health,www.doh.nhs.uk10.LES specification, www.natpact.nhs.uk/primarycarecontracting/imp.php?cat=enh