Development of a text message intervention aimed at reducing alcohol-related harm in patients admitted to hospital as a result of injury.

BACKGROUND: Screening for alcohol misuse and brief interventions (BIs) for harm in trauma care settings are known to reduce alcohol intake and injury recidivism, but are rarely implemented. We created the content for a mobile phone text message BI service to reduce harmful drinking among patients admitted to hospital following an injury who screen positive for hazardous alcohol use. The aim of this study was to pre-test and refine the text message content using a robust contextualisation process ahead of its formal evaluation in a randomised controlled trial. METHODS: Pre-testing was conducted in two phases. First, in-depth interviews were conducted with 14 trauma inpatients (16-60 years) at Auckland City Hospital and five key informants. Participants were interviewed face-to-face using a semi-structured interview guide. Topics explored included: opinions on text message ideas and wording, which messages did or did not work well and why, interactivity of the intervention, cultural relevance of messages, and tone of the content. In a second phase, consultation was undertaken with Maori (New Zealand's indigenous population) and Pacific groups to explore the relevance and appropriateness of the text message content for Maori and Pacific audiences. RESULTS: Factors identified as important for ensuring the text message content was engaging, relevant, and useful for recipients were: reducing the complexity of message content and structure; increasing the interactive functionality of the text message programme; ensuring an empowering tone to text messages; and optimising the appropriateness and relevance of text messages for Maori and Pacific people. The final version of the intervention (named 'YourCall(™)') had three pathways for people to choose between: 1) text messages in English with Te Reo (Maori language) words of welcome and encouragement, 2) text messages in Te Reo Maori, and 3) text messages in English (with an option to receive a greeting in Samoan, Tongan, Cook Island Maori, Niuean, Tokelauan, Tuvaluan, or Fijian). CONCLUSIONS: We have developed a text message intervention underpinned by established BI evidence and behaviour change theory and refined based on feedback and consultation. The next step is evaluation of the intervention in a randomised-controlled trial.

Transferring Patients From Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines.

INTRODUCTION AND AIMS: Transfer from methadone to buprenorphine is problematic for many opioid-dependent patients, with limited documented evidence or practical clinical guidance, particularly for the range of methadone doses routinely prescribed for most patients (>50 mg). This study aimed to implement and evaluate recent national Australian guidelines for transferring patients from methadone to buprenorphine. DESIGN AND METHODS: A multisite prospective cohort study. Participants were patients who transferred from methadone to buprenorphine-naloxone at 1 of 4 specialist addiction centers in Australia and New Zealand. Clinicians were trained in the guidelines, and medical records were reviewed to examine process (eg, transfer setting, doses, and guideline adherence) and safety (precipitated withdrawal) measures. Participants completed research interviews before and after transfer-assessing changes in substance use, health outcomes, and side effects. RESULTS: In all, 33 participants underwent transfer, 9 from low methadone doses (<30 mg), 9 from medium doses (30-50 mg), and 15 from high doses (>50 mg). The majority of high-dose transfers occurred in inpatient settings. There was reasonable guideline adherence, and no complications identified in the low and medium-dose transfers. Three high-dose transfers (20%) experienced precipitated withdrawal, and 7/33 participants (21%) returned to methadone within 1 week of attempted transfer. DISCUSSIONS AND CONCLUSIONS: Transfer is feasible in outpatient settings for those transferring from methadone doses below 50 mg; however, inpatient settings and specialist supervision is recommended for higher-dose transfers. The Australian clinical guidelines appear safe and feasible, although further research is required to optimize high-dose transfer procedures.

Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand.

INTRODUCTION AND AIMS: The role of community pharmacists in the provision of opioid substitution treatment (OST) is pivotal and integral to addiction treatment. An online training program for pharmacists in OST management was piloted in New Zealand in 2010, following recognition of the difficulty in recruitment and retention of community pharmacists to provide OST services. Our aim was to evaluate the OST online training that was made available for any community pharmacist in New Zealand and to establish the feasibility and acceptability of this format of training for community pharmacists. The evaluation explored participants' attitudes, skills and knowledge both pre- and post-training in OST. DESIGN AND METHODS: All pharmacists registering to participate in the training program were asked to complete an evaluation questionnaire immediately before (pre) and immediately after (post) completing the training. Participants were also invited to participate in a brief 10 min structured telephone interview about their training experience. RESULTS: In the first 4 months 190 pharmacists commenced the training; 101 completed both evaluations. Improvements in the confidence and skills of pharmacists were demonstrated through both the quantitative and qualitative analyses. Statistically significant changes in attitudes were also demonstrated. Overall the OST training was well received and the online format was feasible and highly acceptable. DISCUSSION AND CONCLUSION: Online training is an appropriate and economical method of improving pharmacists' clinical skills with respect to this client group, and has the potential to reach a wider audience of pharmacists. Further research is required to investigate OST client experiences in community pharmacy.

Tsunami: understanding mental health consequences and the unprecedented response.

The 26th December 2004 saw a disaster brought on by massive waves - the Asian Tsunami. Millions of people died or were affected to varying degrees. The mental health aftermath did not only hit the Tsunami affected areas but it also sent ripples globally. Financial and humanitarian aid was overwhelming. This review brings together the mental health consequences and the global response. It provides a systematic overview of the mental health problems both within the affected areas and globally. It considers different levels and intensities of mental health problems both in affected areas and globally and explores the effects on vulnerable groups. It describes the unprecedented response and highlights the importance of providing culturally and contextually sensitive, integrated and co-ordinated interventions, informed by qualitative and quantitative assessment of needs, urgency and resource availability. The review also provides a retrospective view on the drivers of such a response.

The mental health care system in Malta.

The Maltese Islands are located in the Mediterranean Sea and have a total area of 316 km2. They consist of three inhabited islands - Malta (the largest of the group), Gozo and Comino - and two uninhabited islands - Filfla and Cominotto. Malta is a democratic republic. Since its independence in 1964, Malta has played a more significant part in international relations. It became a member of the Commonwealth, the United Nations, the World Health Organization and several other organisations. In May 2004, Malta also became a member of the European Union.