Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.

INTRODUCTION AND AIMS: To estimate the prevalence of risky drinking among customers in community pharmacies and to explore customer attitudes towards screening and brief intervention (SBI). DESIGN AND METHODS: Cross-sectional, anonymous survey, using random selection of community pharmacies in New Zealand to collect data using self-completion questionnaires and an opportunity to enter a prize draw. Participants were customers/patients attending the community pharmacy on a specific, randomly selected day (Monday to Friday) in one set week. Alcohol Use Disorder Identification Test (AUDIT)-C using a cut-off score of 5 was used to measure risky drinking. Attitudes towards pharmacists engaging in SBI for risky drinkers were measured. RESULTS: 2384 completed customer/patient questionnaires from 43 participating pharmacies. Almost 84% ever drank alcohol and using a score of 5 or more as a cut-off, 30% of the sample would be considered as risky drinkers. Attitudes were generally positive to pharmacists undertaking SBI. Logistic regression with AUDIT-C positive or negative as the dependent variable found those taking medicines for mental health and liver disease being more likely to score negative on the AUDIT-C, and smokers and those purchasing hangover cures were more likely than average to have a positive AUDIT-C screen. DISCUSSION AND CONCLUSIONS: This study indicates there is scope for community pharmacists to undertake SBI for risky drinking, and that customers find this to be acceptable. Targeted screening may well be useful, in particular for smokers. Further research is required to explore the effectiveness of SBI for risky drinkers in this setting.

Four policies to end the sale of cigarettes and smoking tobacco in New Zealand by 2020.

AIM: To phase out sales of cigarettes and of smoking tobacco products in New Zealand by the year 2020. CURRENT SITUATION: 99% of tobacco is smoked as cigarettes. Cigarettes are highly addictive, lethal, and cannot be made safer. Since 1950 commercial cigarettes have prematurely killed over 160,000 New Zealanders. Despite causes-disease warnings on tobacco packaging (from 1987) and graphic warnings (2007), bans on tobacco advertising and promotions (1990), bans on indoor workplace smoking (1990, 2004), subsidies on medicinal nicotine (2000), and despite one-third of smokers annually making serious attempts to quit, 1 in 5 New Zealand adults smoke, 2 in 5 Maori adults smoke, and cigarette consumption per adult remains virtually unchanged since 2003. Four in 5 smokers regret they ever started. PROPOSED POLICIES: Four policies combined could make cigarette smoking less attractive and the use of nicotine-only products more attractive, with respect to relative price, availability and addictiveness. These mean increasing tax on all cigarettes equally; and a bill to strengthen the Smoke-free Environments (SFE) Act: to allot cigarette sales quotas and then gradually lower them; reduce the nicotine content of cigarettes gradually by a sinking lid or by nicotine tax; and permit the sale of satisfying non-combustible nicotine-only products for smokers. As supply reduces, prices rise, and nicotine satisfaction decreases, smokers will quit; and black market risk will be minimised. Commercial cigarettes will no longer be obtainable, and even if some smoke tobacco grown legally for their own use, or even if some is obtainable illegally, tobacco consumption will greatly reduce. CONCLUSION: The smoking of tobacco sold legally kills 5000 New Zealanders annually. The SFE Act can be amended to phase out legal sales within this decade. Intensive policy research is needed now as public interest increases. Support from the public and from legislators to promote a suitable amendment bill is now needed.

Screening for alcohol misuse in elderly primary care patients: a systematic literature review.

BACKGROUND: Alcohol problems in the elderly are common and frequently undetected, and therefore a potential target for a screening program. METHOD: Using Medline, Psychinfo and reference lists from relevant publications, articles were identified testing pen-and-paper screens in the primary care population aged over 60 years. RESULTS: Using standard definitions of alcohol problems, conventional screens adapted for use in the elderly have performances similar to screens in the younger primary care population. However, it can be argued that special screens perform better for the elderly. CONCLUSIONS: The Alcohol Use Disorders Identification Test is a useful screen for detecting harmful and hazardous drinking in the elderly while the CAGE is valuable when screening for dependence. In the future, the Alcohol-Related Problems Survey, a computer-based screen, may prove to be superior if practical implementation problems can be overcome.

Alcohol assessment: the practice, knowledge, and attitudes of staff working in the general medical wards of a large metropolitan hospital.

AIMS: To measure the prevalence of routine alcohol assessment; to assess its clinical utility in the general medical wards of a large urban hospital; and to assess medical and nursing staff knowledge with regard to standard drink measures and recommended drinking limits as well as their attitudes towards alcohol assessment. METHODS: The prevalence of alcohol assessment and the clinical utility of the resulting information was determined via a retrospective file review (n=109). The knowledge and attitudes of medical and nursing staff were measured via questionnaire (n=106). RESULTS: The file review data indicated 78% (+/-7.25) of patients admitted to the general medical wards were queried with regard to their alcohol consumption. However, the clinical utility of the recorded information was generally poor and the accuracy questionable. Only 12% of questionnaire respondents were able to accurately identify the standard drink equivalents for beer, wine, and spirits and only 8% were able to accurately identify the recommended drinking limits (per drinking occasion and per week) for both males and females. Attitudes towards alcohol assessment were positive. CONCLUSIONS: Patient alcohol consumption is frequently assessed, but the clinical utility of the resulting information is limited. The use of a structured alcohol screen and the provision of appropriate staff training are recommended.