Transcript ADDHIT - Bristol Health Partners

Addiction Health Integration
Team- ADDHIT
Matt Hickman, Barbara Coleman, Tim Williams
Jo Kesten, Katie Porter, David Troy
Acknowledgements
• NIHR Collaborations for Leadership in Applied
Health Research and Care (CLAHRCs) West
• NIHR Health Protection Research Unit in
Evaluation of Interventions
• Sabi Redwood, Maggie Telfer, Rachel Ayres,
Jane Neale, Jody Clarke, Isabel Oliver, Peter
Vickerman
• Clare Fleming, Jelena Savović, Helen Thorely,
Tim Jones, Elsa Marques
• Marcus Munafo, Olivia Maynard, Angela
Attwood
ADDHIT
Aim
support the development and
commissioning of evidence-based
services to improve the health of people
dependent on drug and alcohol and
reduce drug and alcohol related harm
ADDHIT
Research Opportunities
• Evaluating the impact of opiate substitution treatment on
drug related deaths in the population (NIHR HS&DR)
• How to improve HCV case finding in primary care and
specialist drug clinics (NIHR PHP)
• Investigate the cost-effectiveness of Needle Exchange
interventions (NIHR PHP)
• Pilot Trial of alcohol screening and brief intervention
(ASBI) in custody suites (NIHR SPHR)
• Evaluation of ASBI training and delivery for young
people services in NHS, Schools, CJS (NIHR SPHR)
• Scope Health Impact Assessment of Licensing Policy
(NIHR SPHR)
ADDHIT
Progress
• Low vs high dead space syringes: an investigation of user
preferences and attitudes (CLAHRC West & NIHR HPRU)
• Systematic review – could addressing malnutrition in
alcohol dependent people prevent cognitive deficit and
alcohol related brain damage (CLAHRC West)
• Evaluation on efficacy of straight beer glasses to reduce
alcohol consumption in the general population (NIHR
PHP).
Low versus high dead space syringes
• High Dead Space Syringes (HDSS) contain ten times more “dead space” between the
plunger and needle and transfer more blood if re-used than Low Dead Space Syringes
(LDSS)
• HCV and HIV survive for longer in HDSS vs LDSS
• Increasing the proportion of LDSS in circulation could significantly reduce the prevalence
of blood-borne viruses
• WHO and NICE recommend needle and syringe programmes offer LDSS
• Recommended that needle and syringe programmes supply injecting equipment suited
to the needs of local drug users
Research questions:
1. How acceptable are LDSS to injecting drug users?
2. Is a public health intervention needed to encourage the provision and use of
LDSS?
An investigation of user preferences
and attitudes
Study objectives
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To systematically review literature on LDSS (including interventions encouraging their use)
To explore the views of 25-35 injecting drug users and 10-15 professionals and volunteers who work
with them on the use of LDSS
To develop evidence-based recommendations for the introduction of LDSS and determine need for
public health intervention
Qualitative methods
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Two study sites in the South West of England
Maximum variation sampling (range of demographic characteristics, drug type and injecting
preferences)
Semi-structured one-to-one interviews exploring:
– Experiences of different types of syringes
– How the available options are chosen between
– Facilitators, barriers and processes of changing injecting equipment
– Attitudes towards LDSS using a sorting task (ordering features of LDSS by importance)
Progress
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Review in draft
Interviews underway
Alcohol dependency and malnutrition
in the homeless population
• Malnutrition causes brain damage (confusion,
poor memory, balance and co-ordination
problems), may impair wound healing and the
ability to change behaviour.
• Drinkers are not underweight as they get empty
calories from alcohol.
• Few papers on intervention trials. No clear way
forward.
• Public Health alcohol lead and Homeless Health
GP worked together to develop the bid, sharing
papers, and discussing how to present the case.
Alcohol dependency and
malnutrition: systematic review
• Q: What are the effective and cost-effective
interventions for preventing and/or correcting
micronutrient deficiencies and other forms of
malnutrition and related comorbidities in a
population of homeless and vulnerably housed
persons with alcohol dependency?
• Meta-analysis: Malnutrition profile in a
population of homeless and vulnerably housed
persons with alcohol dependency.
• Then develop a research bid for an intervention
Lab Experiment Drinking Data
* p =* 0.007
Feasibility Study
• Run in 3 public houses in Bristol over 2
weekends
• Either all straight or curved half-pint and pints
• Monetary takings as proxy for consumption
• Implementation of intervention – takings
reduced by:
• -24% (95% CI -77% reduction to 29% increase)
• Future trial: 30 pubs over 6 months (multi-site
- NIHR PHP “Choice Architecture” theme
ADDHIT
Future plans
• Systematic Review on Models of Community
Alcohol Detox (and community detox vs.
hospital/residential)
• Investigate community MRSA outbreaks among
PWID – enhance surveillance and develop and
pilot interventions
• Investigate gabapentin and pregabalin misuse,
risk and strategies to prevent drug related harm
• Conduct Health Impact Assessment of new
psycho-active substances
• Alcohol Policy in Bristol
ADDHIT Members
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Bristol City Council
University of Bristol
University of the West of England
ROADs and other service providers
NHS England
Clinical Commissioning Group
GPSIs
University Hospitals Bristol
North Bristol Trust
Public Health England
Police
Probation