andrew mcauley , christine goodall, graham ogden, simon shepherd, karen cruikshank
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Delivering Alcohol Screening and Brief Interventions in General Dental Practice: Rationale & Overview of the Evidence. Andrew McAuley , Christine Goodall, Graham Ogden, Simon Shepherd, Karen Cruikshank. Background. - PowerPoint PPT PresentationTRANSCRIPT
Delivering Alcohol Screening and Brief Interventions in General
Dental Practice: Rationale & Overview of the
Evidence
Andrew McAuley, Christine Goodall, Graham Ogden, Simon Shepherd, Karen Cruikshank
Background
SIGN74. The management of harmful drinking and alcohol dependence in primary care (2003)
“…all healthcare professionals have a role to play in identifying harmful and hazardous drinkers…”
So what role for the dentist?
Alcohol and Oral Cancer Alcohol consumption (alongside
smoking) increases the risk of developing oral cancer and periodontal disease (Hashibe et al, 2007; Amaral et al, 2008 & 2009)
The incidence of oral cancer in the UK is increasing Increases significant across
younger age-groups and in both sexes (Conway et al, 2006)
Strongly related to social and economic deprivation (Conway et al, 2008)
Linked to the parallel increases in alcohol consumption over the last 50 years risk for those drinking 20 units per
week (Llewelyn & Mitchell, 1994)
Oral Cancer: Incidence
0
2
4
6
8
10
12
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
20
05
20
07
Year of diagnosis
Rat
e p
er 1
00,0
00 p
op
ula
tio
n
males females persons
Age standardised (European) incidence rates, by sex, oral cancer, Great Britain, 1975-2007
Source: cancer research UK
Alcohol and Oral Health
There are many other clinical reasons that dentists should ask about alcohol:o Non-carious tooth surface
loss o Medical problems such as
bleeding which may affect treatment
o Drug interactions
Oral disease can also be a sign of poorer general health and well-being.
Alcohol, violence and facial injury
In the West of Scotland…
o 73% of facial injuries due to interpersonal violence
o 82% drinking at the time of injury
(Goodall et al, 2008)
Policy Context
DoH. Modernising NHS Dentistry – Implementing the NHS Plan (2000)
Scottish Executive. Plan for Action on Alcohol Problems (2002)
HEAT: H4 Alcohol Brief Interventions (2008)
British Dental Association Oral Health Inequalities Policy (2009)
The forgotten tribe? Routine alcohol screening and intervention in GDP is relatively
uncommon (Macpherson et al, 2003; Cruz et al, 2005; Miller et al, 2006; Dyer & Robinson, 2006; Shepherd et al, 2011)
We assume doctors, nurses, pharmacists etc will tackle public health issues associated with alcohol and drugs
Dentists often get overlooked
We don’t expect dentists to do this - or do we?o Patients expect dentists to ask them about alcohol and are
receptive to advice (Miller et al, 2006; Goodall, 2006 & 2007; Shepherd et al, 2009)o Dentists view provision of alcohol advice as relevant to their
practice support of relevance (Dyer & Robinson, 2006)
Until Now?...
The case for using alcohol screening and brief interventions in GDP…
Screening Detection of alcohol-related problems and treatment is
facilitated by use of appropriate screening tools (Raistrick et al, 2006)
No formally recognised screening tool specifically designed for use within general dental practice - AUDIT?...
o Using AUDIT; 31% of dental patients in Scotland drinking at hazardous, harmful or dependent levels (Goodall et al, 2006 & 2007)
o Using AUDIT-C; 25% of patients attending dental practice in USA were drinking at hazardous levels (Miller et al, 2006)
Alcohol Brief Interventions (ABIs)
A short, evidence-based, structured conversation about alcohol consumption that seeks in a non-confrontational way to motivate and support an individual to think about and/or plan changes in their drinking behaviour in order to reduce their consumption and/or their risk of harm.
(NHS Health Scotland, 2008)
ABIs: Evidence
Strong evidence for the effectiveness of ABIs in those drinking at harmful / hazardous levels (Raistrick et al, 2006; SIGN74; NICEPHG24; WHO)
Primary Care, A&E
The evidence for effectiveness in delivery of ABIs in GDP has yet to be established but…Identified as a potential setting where they
can be effective (Cruz et al, 2005; Goodall, 2006 & 2007; Dyer et al, 2006; Shepherd et al, 2009; NICEPHG24, 2010)
ABI in GDP: Plausible Theory?
Potential to improve oral and general health Equitable Sustainable Potential to reduce health inequalities:
65% of adults in Scotland are currently registered with a dentist (ISD, 2010)
80% of adults have had access to NHS general dental services over a six-year period (Tilley & Chalkley, 2005)
GDP Health Improvement
Increasing role and willingness to develop skills & participation further (Dyer & Robinson, 2006; McCann et al, 2000)
~ 90% of Scottish dentists having already expanded their remit to include advice to patients on smoking cessation (Chestnutt & Binnie, 1995)
50% seeing a specific role for dentists in counselling patients to stop (Chestnutt & Binnie, 1995)
Patients also consider smoking cessation as part of the GDP role (Campbell et al, 1999)
Barriers
Time
“….if I had lots of time with a patient I think it would be a nice thing to do…I’m much more interested in the bigger picture of their whole health”
Funding
“ ..if I was getting paid to do it I might do it…(alcohol screening)”
Training
“ we have never been educated about how to help someone.. Where do you start if you’ve actually no experience..”
Confidence
“ there’s a fine line…between trying to be helpful to someone and give them advice and being patronising..”
(Goodall, 2006 & 2007)
(Warnakulasuriya & Johnson, 1990; Macpherson et al, 2003; Cruz et al, 2005; Shepherd et al, 2009 & 2010 & 2011)
Facilitators Patients are receptive to
alcohol advice (Miller et al, 2006; Shepherd et al, 2009; Goodall, 2006 & 2007)
Patients were not offended by alcohol screening (Goodall, 2006 & 2007)o Most felt it was important
for the dentist to ask about alcohol (62.9%)
o Most thought it was relevant to their oral health (83.1%) and were happy to discuss it (74.2%)
Frequency & length of dental appts (Cruz et al, 2005)
Were you offended by being asked about your drinking?
0
50
100
150
200
Yes NSF NoN
umber o
f patie
nts
Future?
Alcohol training for dentists?o Embed within the undergraduate curriculumo Provide PG educationo Train
Utilise Professionals Complimentary to Dentistry (PCDs)?
Payment for an alcohol service in GDP?o Oral Heath Assessment Review (OHAR)?
Conclusions Alcohol is a key risk factor for oral cancer
Alcohol is associated with a range of other adverse oral health outcomes
GDPs are attended by the majority of the adult population over time
~ 30% of GDP Patients drinking at Harmful and Hazardous levels.
Increasing role of dentists in health improvement
Patients receptive to screening and intervention
Policy drivers in place
Oral Health Assessment Review – a window of opportunity?
Any questions?Andrew McAuleyPublic Health Adviser (Substance Misuse / Alcohol)NHS Health Scotland Public Health Science, EfA TeamElphinstone House65 West Regent StreetGlasgow, G2 2AF
Tel: 0141 354 2935 (ext: 2935)Fax: 0141 354 [email protected] www.healthscotland.com
McAuley, A., Goodall, CA., Ogden, GR., Shepherd, S., & Cruikshank, K. 2011. Delivering alcohol screening and alcohol brief interventions within general dental practice: Rationale and overview of the evidence. Br Dent J, 210: E15.