Evaluating the impact of minimum unit pricing for alcohol in Scotland: a theory-based synthesis of the evidence.

BACKGROUND: In May 2018, the Scottish Government set a minimum unit price (MUP) of £0·50 per unit of alcohol sold in Scotland to reduce alcohol-related health harms. We synthesised evidence to establish the effects of MUP on alcohol-related health and social harms, at population level and within specific societal groups. METHODS: We did a theory-based synthesis of academic and grey research evidence about impacts of MUP in Scotland, including compliance, price, consumption, health outcomes, social outcomes, public attitudes, and the alcoholic drinks industry. We searched the Public Health Scotland's MUP evaluation portfolio and relevant grey and academic literature for studies published between Jan 1, 2018, and Jan 31, 2023. We conducted systematic searches and screening of bibliographic databases (Scopus, Public Health Database, EconLit, MEDLINE, ProQuest Public Health, Social Policy and Practice, NHS Scotland Knowledge Network Library Search, medRxiv, bioRxiv, SSRN, Idox Knowledge Exchange, Social Policy & Practice, and Google Search). Search terms were tailored to specific databases but included variants of the terms "minimum unit pricing", "alcohol", and "policy". Eligibility literature included English-language research into impacts of MUP on either the population of Scotland or a specific subpopulation. We excluded conference abstracts, literature reviews, articles that did not report research, and research based solely on data from before the introduction of MUP. FINDINGS: We included 40 reports in our analysis. On the balance of evidence, MUP improved population-level health outcomes, demonstrated most starkly by a 13·4% reduction in alcohol-attributable deaths in Scotland compared with England. There was no evidence of substantial negative effects on the alcoholic drinks industry or social harms at the population level. While population-level outcomes were predominantly positive, some qualitative evidence suggests that MUP might have exacerbated health and social harms for some individuals or groups, especially those with alcohol dependence who were financially vulnerable. INTERPRETATION: MUP in Scotland has been effective in reducing alcohol-related health harms, with little evidence of any effect on social harms. If MUP continues, policymakers should consider raising the £0·50 per unit threshold and supplementing the intervention with policies or services to address any unintended negative effects experienced by specific groups. The synthesis is persuasive due to the prospective, theory-based design of the evaluation portfolio and the quality and comprehensiveness of the evidence. FUNDING: Scottish Government.

Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study.

BACKGROUND: Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations. METHODS: Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group. FINDINGS: MUP in Scotland was associated with a significant 13·4% reduction (95% CI -18·4 to -8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (-8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland. INTERPRETATION: The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm. FUNDING: Scottish Government.

What do young Australian women want (when talking to doctors about contraception)?

BACKGROUND: Access to most contraceptives in Australia requires a prescription from a doctor, and it has been shown that doctors can influence women's decision-making with respect to contraception. However, little research has documented how women experience their interactions with doctors within the context of a contraceptive consultation. Understanding such experiences may contribute to our knowledge of factors that may influence women's contraceptive decisions more broadly. METHODS: We report on findings from the Contraceptive Use, Pregnancy Intentions and Decisions (CUPID) survey of young Australian women, a large-scale longitudinal study of 3,795 women aged 18-23 years. We performed a computer-assisted search for occurrences of words that indicated an interaction within the 1,038 responses to an open-ended question about contraception and pregnancy. We then applied a combination of conventional and summative content analysis techniques to the 158 comments where women mentioned an interaction about contraception with a doctor. RESULTS: Our analysis showed that women desire consistent and accurate contraception information from doctors, in addition to information about options other than the oral contraceptive pill. Some young women reported frustrations about the choice limitations imposed by doctors, perceived by these women to be due to their young age. Several women expressed disappointment that their doctor did not fully discuss the potential side-effects of contraceptives with them, and that doctors made assumptions about the woman's reasons for seeking contraception. Some women described discomfort in having contraception-related discussions, and some perceived their doctor to be unsupportive or judgmental. CONCLUSIONS: Both the content and the process of a contraceptive consultation are important to young Australian women, and may be relevant contributors to their choice and ongoing use of a contraceptive method. These findings provide useful insights into aspects of the patient-provider interaction that will enhance the efficacy of the contraceptive consultation. It is recommended that doctors adopt patient-centred, shared decision-making strategies to support women in making choices about contraception that suit their individual circumstances. We also acknowledge the need to involve other health care providers, other than doctors, in educating, informing, and assisting women to make the best contraceptive choice for themselves.

How we developed Doctors Speak Up: an evidence-based language and communication skills open access resource for International Medical Graduates.

BACKGROUND: Some International Medical Graduates (IMGs) need to develop language and communication skills for patient-centred care but have limited opportunities to do so. AIM: To develop an evidence-based, language and communication skills web resource for IMG doctors and supervisors, focussing on culturally challenging patient interviews. METHODS: Forty-eight IMGs participated in four practice OSCEs. We video-recorded the interactions and applied discourse analytic methods to investigate salient language and communication features. RESULTS: The findings from the OSCE workshops showed that many participants demonstrated aspects of patient-centred interviewing but were hindered by limited interactional competence to elicit information and negotiate behaviours as well as a limited repertoire of English grammar, vocabulary, and phonological phrasing for effective interaction. These findings guided the choice of content and pedagogy for the development of the web-based resource Doctors Speak Up. CONCLUSION: Evaluation and uptake of the Doctors Speak Up website confirm the demand for a resource combining targeted communication skills and language instruction. Over 19 500 users visited the website between March 2012 and November 2013.

Medical students' perceptions of role models on clinical placements.

BACKGROUND: Clinical placements have been reported as being challenging, demanding and rewarding for health professional students. For medical students, clinical placements are often their first interaction with other health professionals, who are often graduates. This study was designed to explore medical students' experiences of a clinical placement, in which their perceptions about role models from the same or other disciplines emerged. METHODS: A total of three focus groups (n = 15) were conducted with medical students following the completion of their clinical placement rotation in palliative and rehabilitative settings. FINDINGS: Role models and influential figures were key themes to emerge from the focus group data, reflecting an underlying tension between the practitioners that the students wanted to learn from and the practitioners who were actually willing, and available, to teach and model certain clinical skills. DISCUSSION: The extent to which doctors, nurses and allied health professionals were seen as role models became a central focus in exploring how the professional identity of students is influenced on clinical placement.

Medical students' interprofessional experiences in a rehabilitation and palliative care placement.

The majority of interprofessional learning literature focuses on initiatives within pre-clinical or simulated learning environments, with a paucity of research exploring the variation in impact of exposure to nurses and other health professionals in different health care settings. This study aimed to explore the experiences and attitudes of medical students following scheduled placements in palliative and rehabilitative care units. Three focus groups were conducted by researchers independent of the clinical school, to explore the attitudes of first clinical year medical students towards, and experiences of, a clinical placement that provided the opportunity to develop interprofessional skills. Students responded differently to the expectation put upon them to initiate their own learning experiences. A number of students felt that being asked to focus on clinical skill development conflicted with the assessment demands of the medical curriculum. This, in turn, contributed to a missed opportunity for them to learn with, from and about nurses and other health professionals. The driver of assessment was seen to be more important to their training. This emphasises the importance of including an assessment of interprofessional skills if we want to ensure students achieve these skills. If medical students are not going to be assessed on interprofessional knowledge, skills and attitudes then a curriculum orientation to the value of interprofessional practice is required.

Telecommunications as a means to access health information: an exploratory study of migrants in australia.

BACKGROUND: Health policies increasingly promote e-health developments (e.g., consumers' access to online health information) to engage patients in their health care. In order to make these developments available for culturally and socially diverse communities, not only do Internet accessibility, literacy and e-health literacy need to be taken into account, but consumers' preferences and information seeking behaviours for accessing health information have also to be understood. These considerations are crucial when designing major new health policy directions, especially for migration destination countries with culturally diverse populations, such as Australia. The aim of this study was to examine how people from a culturally and linguistically diverse (CALD) community use telecommunications (phone, mobile, Internet) to access health information. DESIGN AND METHODS: A case study was conducted using a questionnaire exploring the use of telecommunications to access health information among CALD people. The study was carried out at a community health centre in a socially and economically disadvantaged area of Melbourne, a city of 4 million people with a large CALD and migrant population. Questionnaires were translated into three languages and interpreters were provided. Fifty-nine questionnaires were completed by users of the community health centre. RESULTS: Most of the CALD participants did not have access to the Internet at home and very few reported using telecommunications to access health information. CONCLUSIONS: The findings of the study suggest that telecommunications are not necessarily perceived to be an important channel for accessing health information by members of the CALD community.