Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care.
Journal article
Madden, M., Stewart, D., Mills, T. and McCambridge, J. (2023). Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care. Addiction science & clinical practice. 18 (1), p. 22. https://doi.org/10.1186/s13722-023-00378-x
| Authors | Madden, M., Stewart, D., Mills, T. and McCambridge, J. |
|---|---|
| Abstract | Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles. [Abstract copyright: © 2023. The Author(s).] |
| Keywords | Qualitative Research; Humans; Professional Role; Pharmacists; Clinical pharmacy; Medication review; Brief intervention; Primary Health Care; Polypharmacy; Qualitative research; Alcohol |
| Year | 2023 |
| Journal | Addiction science & clinical practice |
| Journal citation | 18 (1), p. 22 |
| Publisher | Springer |
| ISSN | 1940-0640 |
| Digital Object Identifier (DOI) | https://doi.org/10.1186/s13722-023-00378-x |
| Publication dates | |
| Online | 30 Mar 2023 |
| Publication process dates | |
| Accepted | 23 Mar 2023 |
| Deposited | 14 Apr 2023 |
| Publisher's version | License File Access Level Open |
Permalink -
https://openresearch.lsbu.ac.uk/item/93vx8
Download files
71
total views22
total downloads1
views this month0
downloads this month
Export as
Related outputs
Challenges to the real-world delivery of brief alcohol interventions in the custody suite: qualitative study
Jarrett, M., Mills, T., Mallion, J., Sykes, S., Wills, J. and Chaplin, E. (2024). Challenges to the real-world delivery of brief alcohol interventions in the custody suite: qualitative study. BJPsych bulletin. https://doi.org/doi:10.1192/bjb.2024.48Involving Lived Experience in regional efforts to address gambling-related harms: going beyond ‘window dressing’ and ‘tick box exercises’
Jenkins, C., Mills, T., Grimes J, Bland C, Reavey, P., Wills, J. and Sykes, S. (2024). Involving Lived Experience in regional efforts to address gambling-related harms: going beyond ‘window dressing’ and ‘tick box exercises’. BMC Public Health. 24, p. 384. https://doi.org/10.21203/rs.3.rs-3658745/v1Evaluation of a city-region initiative to galvanise a community response to gambling-related harms
Jenkins, C and Mills, T (2023). Evaluation of a city-region initiative to galvanise a community response to gambling-related harms. European Journal of Public Health. 33 (Supplement_2). https://doi.org/10.1093/eurpub/ckad160.676Harnessing lived experience in a community-based intervention to address gambling-related harms
Jenkins, C, Mills, T, Reavey, P, Moss, A, Sykes, S, Wills, J and Grimes, J (2023). Harnessing lived experience in a community-based intervention to address gambling-related harms. European Journal of Public Health. 33 (Supplement_2). https://doi.org/10.1093/eurpub/ckad160.1654‘Odds Are: They Win’: a disruptive messaging innovation for challenging harmful products and practices of the gambling industry
T. Mills, J. Grimes, E. Caddick, C.L. Jenkins, J. Evans, A. Moss, J. Wills and S. Sykes (2023). ‘Odds Are: They Win’: a disruptive messaging innovation for challenging harmful products and practices of the gambling industry. Public Health. 224, pp. 41-44. https://doi.org/10.1016/j.puhe.2023.08.009Consultation skills development in general practice: findings from a qualitative study of newly recruited and more experienced clinical pharmacists during the COVID-19 pandemic.
Madden, M., Stewart, D., Mills, T. and McCambridge, J. (2023). Consultation skills development in general practice: findings from a qualitative study of newly recruited and more experienced clinical pharmacists during the COVID-19 pandemic. BMJ Open. 13 (4), p. e069017. https://doi.org/10.1136/bmjopen-2022-069017Development of a ‘real-world’ logic model through testing the feasibility of a complex healthcare intervention: the challenge of reconciling scalability and context-sensitivity
Mills, T., Shannon, R., O'Hara, J., Lawton, R. and Sheard, L. Development of a ‘real-world’ logic model through testing the feasibility of a complex healthcare intervention: the challenge of reconciling scalability and context-sensitivity. Evaluation. https://doi.org/10.1177/13563890211068869Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial
Baxter, R., Murray, J., O'Hara, J., Hewitt, C., Richardson, G., Cockayne, S., Sheard, L., Mills, T. and Lawton, R. (2022). Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial. Pilot and Feasibility Studies. 6 (123). https://doi.org/10.1186/s40814-020-00655-5Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the ’Your Care Needs You’ intervention versus usual care
Baxter, R., Murray, J., Cockayne, S., Baird, K., Mandefield, L., Mills, T., Lawton, R., Hewitt, C., Richardson, G., Sheard, L. and O.Hara, J. (2022). Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the ’Your Care Needs You’ intervention versus usual care. Pilot and Feasibility Studies. 8 (222). https://doi.org/10.1186/s40814-022-01180-3A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home
Shannon, R., Baxter, R., Hardicre, N., Mills, T., Murray, J., Lawton, R. and O'Hara, J. (2022). A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home. Health Expectations. https://doi.org/10.1111/hex.13560Integration of a clinical pharmacist workforce into newly forming primary care networks: a qualitatively driven, complex systems analysis
Mills, T., Madden, M., Stewart, D., Gough, B. and McCambridge, J. (2022). Integration of a clinical pharmacist workforce into newly forming primary care networks: a qualitatively driven, complex systems analysis. BMJ Open. 12 (11). https://doi.org/10.1136/bmjopen-2022-066025Early implementation of the structured medication review in England: a qualitative study.
Madden, M., Mills, T., Atkin, K., Stewart, D. and McCambridge, J. (2022). Early implementation of the structured medication review in England: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners. https://doi.org/BJGP.2022.0014Multiple meanings of resilience: Health professionals' experiences of a dual element training intervention designed to help them prepare for coping with error
Janes, G., Harrison, R., Johnson, J., Simms-Ellis, R., Mills, T. and Lawton, R. (2021). Multiple meanings of resilience: Health professionals' experiences of a dual element training intervention designed to help them prepare for coping with error. Journal of Evaluation in Clinical Practice. 28. https://doi.org/10.1111/jep.13555Using qualitative process evaluation in the development of a complex intervention to advance person-centred practice by pharmacists: The Medicines and Alcohol Consultation (MAC)
Madden, M., Morris, S., Stewart, D., Atkin, K., Gough, B., Mills, T. and McCambridge, J. (2021). Using qualitative process evaluation in the development of a complex intervention to advance person-centred practice by pharmacists: The Medicines and Alcohol Consultation (MAC). Social Science and Medicine - Qualitative Research in Health. 1. https://doi.org/10.1016/j.ssmqr.2021.100012The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis
Janes, G., Mills, T., Budworth, L., Johnson, J. and Lawton, R. (2021). The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis. Journal of Patient Safety. 17 (3), pp. 207-216. https://doi.org/10.1097/PTS.0000000000000807Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention
Johnson, J., Simms-Ellis, R., Janes, G., Mills, T., Budworth, L., Atkinson, L. and Reema, H. (2020). Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention. BMC Health Services Research. 20. https://doi.org/10.1186/s12913-020-05948-2