An evaluation to assess the implementation of NHS delivered Alcohol Brief Intervention: final report

In three years from 2008 Scottish national policy drove delivery of nearly 175,000 brief alcohol interventions, testament to what can be done when policy is backed by funding and infrastructure and incentive payments contingent on implementation. Leverage and acceptance were greatest in primary care, where the vast majority of the work took place.
Alcohol Brief Interventions (ABIs) have been identified as an effective strategy for treating people whose alcohol consumption is posing a risk to their health. As part of its Alcohol Strategy the Scottish Government established a health improvement target for NHS health boards, supported by additional funding. This required NHS Health Scotland to deliver 149,449 ABIs across three priority settings of primary care, Accident & Emergency (A&E) and antenatal care, between April 2008 and March 2011. A subsequent one year extension target was introduced.
The evaluation aimed to assess the process of implementation of ABIs using both quantitative and qualitative methods. The focus was mainly on primary care but also includes some findings relating to A&E and antenatal settings.
The evaluation found a considerable degree of variation across Scotland in organisational structures and models of delivery. However, a number of common features were also identified. Those which appeared to support implementation included: the availability of funding; nationally co-ordinated and locally supported training opportunities; and national, health board and setting level ‘leaders’ able to support and encourage implementation. Perceived barriers included: the lack of ‘lead in’ time to set up organisational structures; competing priorities; an initial lack of adequately trained staff and difficulties maintaining trained staff levels; and problems associated with the mechanisms for recording delivery. These within-setting and across-board differences and difficulties in recording ABI delivery made it difficult to accurately determine or compare who the programme was reaching. Nonetheless, by March 2011 most boards had met, if not exceeded, the three-year target.