In the UK alcohol misuse leads to an estimated cost to society of £25.1 billion per annum (NHS costs £2.7 billion) and is the third leading cause of ill health
]. Population-level interventions that seek to influence the price, availability and cultural acceptability of heavy drinking are likely to be most effective in reducing these problems
]. These may be complemented by individual-level interventions delivered in health services and elsewhere. The UK Department of Health aims to involve community pharmacists in delivering alcohol brief interventions
]. It has recommended that pharmacy based alcohol interventions should be piloted and evaluated.
Brief interventions are discussions which seek to change views of the personal acceptability of excessive drinking and to encourage self-directed behaviour change. They include simple forms of structured advice and brief counselling. Typically, questions about alcohol use are asked to motivate the person to take action to change drinking where this may be beneficial
]. There is strong evidence to support the effectiveness of BI to reduce alcohol consumption in primary healthcare
]. In 21 randomised controlled trials conducted in primary health care settings with 7,286 participants, those who received BI reduced their alcohol consumption by 41 grams/week (five U.K. units of alcohol) on average compared to those who did not receive BI
]. However there are no trials which have assessed the effectiveness of BI delivered in the community pharmacy setting.
It is useful to think of three types of drinking that are injurious to health: a) Hazardous drinking (which carries a risk of harmful consequences to the drinker for example occasional binge drinking); b) Harmful drinking (pattern of drinking already causing psychological or physical damage to health) and c) Dependent drinking (which may benefit from specialist intervention)
]. The World Health Organisation (W.H.O) 10-item Alcohol Use Disorder Identification Test (AUDIT) screening tool has been extensively validated in identifying those whose drinking is hazardous or harmful, including those who are dependent
Guided by the Medical Research Council (MRC) framework for developing and evaluating complex interventions
], the design of this trial has been informed by our previous studies assessing pharmacy customers’ perceptions and the feasibility of BI in community pharmacies
] and studies that recommend establishing the acceptability of discussing alcohol use in health care settings
]. Our NHS Westminster study which assessed 102 pharmacy customers perceptions of BI established that most customers (N
97, 96%) would find it acceptable to discuss their drinking with the pharmacist
]. Our uncontrolled before and after study of BI in community pharmacies in Lambeth involved training 29 community pharmacists in BI and monitoring change in drinking among a cohort of service users
]. Experiences of receiving the service, and the barriers and enablers experienced by study pharmacists were also assessed. A key finding of this study was that pharmacists unfamiliar with BI could be trained to deliver alcohol interventions. In addition involving support staff to inform pharmacy customers about BI and providing regular support to pharmacy staff were found to be important factors in achieving high BI delivery rates in community pharmacies.
This trial builds on previous research undertaken by others, including a questionnaire study in New Zealand exploring attitudes, knowledge and experiences of 101 community pharmacists. These pharmacists reported being motivated to take up BI but expressed a lack of confidence, knowledge and skills to advise customers on their drinking
]. A larger study conducted in New Zealand (2383 customers at 43 pharmacies), also suggested that customers were positive about being offered BI from pharmacies
There has been one published discussion paper assessing the feasibility of BI conducted by community pharmacists in the UK
]. The three feasibility studies discussed in this review (all U.K. cities: London; Glasgow; and Leeds) included a total of 14 pharmacies and 500 customers, from which 30% to 53% were identified as drinking above the UK recommended levels (i.e. women drinking more than 24 grams of ethanol/day and men more than 32 grams of ethanol/day
]. The authors in the discussion paper supported the feasibility of BI delivered in community pharmacies and noted that there had been “little empirical evaluation of the effectiveness of community pharmacy-based services for alcohol misuse”, concluding that large scale effectiveness studies were now needed
To determine if alcohol BI delivered by community pharmacists is effective at reducing hazardous and harmful drinking among pharmacy customers at three-month follow-up compared to a non-intervention leaflet-only control condition.
To identify the pharmacy use and demographic profiles of participants recruited to the trial and pharmacy customers who did not fulfil study inclusion criteria or who refused.
To determine rates of recruitment, refusal and retention among pharmacy customers who are approached to enter the trial.
To conduct a randomised controlled trial of the effectiveness of alcohol BI for hazardous and harmful drinkers accessing community pharmacy services within NHS Hammersmith and Fulham, London, UK.
To assess differences in risky drinking and general health status between BI and control participants after three-months.
To determine participants’ experience of participating in this trial.