How can we support hospital staff to engage in alcohol harm prevention?
When people die from alcohol-related conditions such as liver disease, there have often been missed chances during other hospital visits to prevent or stop their alcohol use from getting worse.
Alcohol harm prevention could include asking patients about drinking, offering advice to help them cut down, or signposting patients to a service where they could get more support. Since the Covid-19 pandemic alcohol related illness and deaths have increased, and pressures on hospital resources and hospital staff have also worsened.
A new study led by researchers from the NIHR ARC North East and North Cumbria has explored possible reasons why hospital staff don’t engage in preventative work to reduce the health harms of alcohol use, and set out recommendations to address these barriers.
The study involved interviewing 30 hospital staff (10 doctors and 30 nurses) in eight hospitals in the North East of England between June and October 2021. The study team included staff from the North East and North Cumbria Integrated Care System, primary care, secondary care, public health, and academia.
What is the issue?
Current NHS clinical guidance require that non-specialist healthcare staff ‘should be competent to identify harmful drinking (high-risk drinking) and alcohol dependence’. This includes having the skills to assess the need for an intervention or to provide an appropriate referral.
Despite this guidance, evidence suggests a range of barriers exist to hospital staff consistently engaging in preventive practices.
The study highlighted a number of specific barriers, including:
- Widespread poverty in the North East region contributes to many patients presenting with complex health needs, including heavy alcohol use, so staff find it hard to know who to prioritise asking about alcohol
- The need to focus on the acute condition that the patient is presenting with
- The ‘stigma’ of alcohol use – some staff were perceived to feel that alcohol use was something patients had brought on themselves and so they did not offer support to these patients.
- This stigma also often prevented patients from openly disclosing their heavy alcohol use with staff or asking for help
- Limited time to engage in preventative work
- The lack of a visible commitment to reducing alcohol related harm at a national level meaning roles related to alcohol are often voluntary rather than formalised
- Staff do not always know how to speak to patients about alcohol or where to refer them to for further support
- Some staff indicated that they didn’t necessarily see it as their responsibility to ask about alcohol and felt others were better placed to do this
- A few staff suggested they had little positive feedback about how patients were helped when they were offered advice or signposted to support around alcohol, meaning they did not see the value in offering this preventative care.
Lead researcher Dr Kat Jackson from Newcastle University, said:
“The research was carried out post-Covid so it provided us with an opportunity to see how our findings compared to literature and the situation pre-pandemic.
“We found that some factors already known to prevent staff supporting people with alcohol use were the same as those before the pandemic. These are staff’s need to focus on the acute presenting condition, time pressures, and staff’s knowledge and skills about how to support people who drink heavily.
“Our study findings also suggest that growing economic disparity means that more people are potentially presenting with alcohol related harm. We found that hospital staff in the North East recognised that harmful alcohol use is common in the patient populations they work with and that they appear to have increased post-Covid-19 pandemic.
“Most staff do not consistently ask patients about alcohol harm, provide support or signpost on to other specialist services which could help them.
“It is sometimes suggested that training alone could improve the delivery of preventative care for alcohol related harm.
“However, our findings suggest that there is a need to address contextual factors – in particular pushing to ensure alcohol is prioritised at a national level, so the stigma towards people who struggle with alcohol use is removed.
“In conclusion, some issues can be addressed at a local policy and practice level e.g., via improved training and support, but system-wide action is needed to enable preventative alcohol work to take place in hospital settings.”
The results from this study, and the wider study it was part of, have already directly shaped the North East and North Cumbria’s regional strategy for the reduction of alcohol harm.
A key element of this is the integrated alcohol workforce strategy for the North East and North Cumbria, which aims to better support the NHS workforce to prevent alcohol harm through:
- Increased awareness of the Chief Medical Officer alcohol guidance
- Improved pathways to community-based alcohol treatment and recovery support
- Improved workforce training and development.
You can read a plain language summary of the research findings, here.
Read the full research paper: Understanding the challenges of identifying, supporting, and signposting patients with alcohol use disorder in secondary care hospitals, post COVID-19: a qualitative analysis from the North East and North Cumbria, England | BMC Health Services Research | Full Text (biomedcentral.com) – published July 2024