Study suggests embedding addiction specialists in GP practices to help problem drinkers

Embedding specialist addictions nurses in general practices in the most disadvantaged areas can bring positive results for those with alcohol problems and should be expanded, according to a study.

The research explored perceptions of the Primary Care Alcohol Nurse Outreach Service (PCANOS) project which sees an addictions nurse located within Deep End GP practices, those which serve the 100 most disadvantaged populations of Scotland.

In 2020, 1,190 people in Scotland died directly because of alcohol, and alcohol-related deaths were 4.3 times higher in the most disadvantaged areas of Scotland compared with the least, according to National Records of Scotland data.

The study, conducted by researchers at the universities of Dundee and Stirling, found that the PCANOS was viewed positively by both practice staff and patients due to its “person-centred” approach, flexible nature, and ability to be tailored to support specific individuals.

Researchers also found that the model enabled collaborative working between practice staff because the addictions nurse was situated there, leading to faster referrals and co-ordinated care between services and with wider community services after discharge.

The report was commissioned by Scottish Health Action on Alcohol Problems (SHAAP) and looked at practices in Glasgow.

Dr Andrea Mohan, principal researcher on the project, from the University of Dundee, said: “People from deprived backgrounds in Scotland continue to experience serious harms such as illness and early death due to alcohol.

“Supporting this group can be challenging as they often have complex health and social needs, and find it difficult to access appropriate services.

“This research study found that benefits can be achieved when a specialist alcohol service, such as the Primary Care Alcohol Nurse Outreach Service, works closely with general practices.

“PCANOS uses a person-centred and co-ordinated care approach to engage and support patients with moderate to severe alcohol problems who are referred by general practices serving some of the most deprived populations in Glasgow.

“It is crucial that a service like PCANOS continues to be funded as our study has shown that it is filling an important gap in alcohol service provision in Glasgow.”

The primary aim of the PCANOS was to engage patients with alcohol problems who have either not engaged with or have low engagement with specialist community alcohol services, and to refer them on to mainstream alcohol services upon discharge.

The study found that the PCANOS is “filling an important gap in service provision”, that of supporting people with moderate to severe alcohol problems who do not engage with other services

Dr Clare Sharp, from the University of Stirling, another of the report’s key researchers, said: “Individuals with moderate to severe alcohol problems often have complex health and social care needs, and we know that for many it is challenging to engage with current alcohol treatment services for various reasons. This is where PCANOS comes in.”

Elinor Jayne, director of SHAAP, said investing in this type of “person-centred, holistic care” could reduce the burden on other NHS services.

She said: “Alcohol harm disproportionately affects people living in Scotland’s most disadvantaged communities, so targeted, innovative services such as this addictions nurse model in Deep End practices in Glasgow are to be celebrated.

“It’s really important that not only is this service continued, but is expanded to all Deep End practices so that we can begin to reduce the harm caused by alcohol in all of Scotland’s most disadvantaged communities.”

Public Health Minister, Maree Todd, said: “I welcome this new report from Scottish Health Action on Alcohol Problems (SHAAP), University of Dundee and University of Stirling on the important work of alcohol nurses in Deep End practices in Glasgow.

“The Scottish Government will carefully consider the findings of the report which highlights the need for more research into the effectiveness of these services for supporting people with moderate to severe alcohol problems who do not engage with alcohol services.

“We are exploring the evidence around Managed Alcohol Programmes and continue to contribute to the running and evaluation of the Simon Community Scotland model being piloted in Glasgow.

“We’re determined to reduce harms where they are greatest and have announced increased investment in tackling problematic alcohol and drug use including consulting on potential restrictions on alcohol advertising, reviewing the level of minimum unit pricing, progressing a review of Alcohol Brief Interventions and improving health information on product labels.”

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