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Lehto M, Pitkälä K, Rahkonen O, Laine MK, Raina M, Kauppila T. The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town. Scand J Prim Health Care 2021; 39:113-122. [PMID: 33851565 PMCID: PMC8293956 DOI: 10.1080/02813432.2021.1910449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study examines whether implementation of electronic reminders is associated with a change in the amount and content of diagnostic data recorded in primary health care emergency departments (ED). DESIGN A register-based 12-year follow-up study with a before-and-after design. SETTING This study was performed in a primary health care ED in Finland. An electronic reminder was installed in the health record system to remind physicians to include the diagnosis code of the visit to the health record. SUBJECTS AND MAIN OUTCOME MEASURES The report generator of the electronic health record-system provided monthly figures for the number of different recorded diagnoses by using the International Classification of Diagnoses (ICD-10th edition) and the total number of ED physician visits, thus allowing the calculation of the recording rate of diagnoses on a monthly basis and the comparison of diagnoses before and after implementing electronic reminders. RESULTS The most commonly recorded diagnoses in the ED were acute upper respiratory infections of various and unspecified sites (5.8%), abdominal and pelvic pain (4.8%), suppurative and unspecified otitis media (4.5%) and dorsalgia (4.0%). The diagnosis recording rate in the ED doubled from 41.2 to 86.3% (p < 0.001) after the application of electronic reminders. The intervention especially enhanced the recording rate of symptomatic diagnoses (ICD-10 group-R) and alcohol abuse-related diagnoses (ICD-10 code F10). Mental and behavioural disorders (group F) and injuries (groups S-Y) were also better recorded after this intervention. CONCLUSION Electronic reminders may alter the documentation habits of physicians and recording of clinical data, such as diagnoses, in the EDs. This may be of use when planning resource managing in EDs and planning their actions.KEY POINTSElectronic reminders enhance recording of diagnoses in primary care but what happens in emergency departments (EDs) is not known.Electronic reminders enhance recording of diagnoses in primary care ED.Especially recording of symptomatic diagnoses and alcohol abuse-related diagnoses increased.
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Affiliation(s)
- Mika Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, City of Vantaa, Finland
| | - Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Merja K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Marko Raina
- Vantaa Health Centre, City of Vantaa, Finland
| | - Timo Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, City of Vantaa, Finland
- CONTACT Timo Kauppila Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Biomedicum 2, Tukholmankatu 8 B FI-00014, Helsinki, Finland
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Phillips T, Coulton S, Drummond C. Burden of Alcohol Disorders on Emergency Department Attendances and Hospital Admissions in England. Alcohol Alcohol 2019; 54:516-524. [PMID: 33724349 DOI: 10.1093/alcalc/agz055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/02/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aims to estimate the prevalence and burden of alcohol disorders on Emergency Department (ED) and hospital inpatients in England through the exploratory analysis of NHS data. METHODS ED attendances and admission data were linked using hospital episode statistics. Diagnoses were preserved at a patient level to identify individuals who had an alcohol attributable diagnosis. Four groups were identified; a) individuals with no alcohol disorder (NAD), b) acute alcohol disorder (AAD), c) chronic alcohol disorder (CAD) and d) those with any alcohol disorder (AD) (b) and c) combined). Associations between ED diagnosis and alcohol disorders were examined using logistic regression adjusted for hospital provider, age and sex. Non-parametric tests were employed examining ED and hospital service use. Cost differences by group was explored using a propensity scored match sample. RESULTS Of the 1.2million subjects 6.7% were identified as having one or more AD accounting for 11.7% of ED attendances, 9.2% of hospital admissions and 7.2% total bed days. Bootstrapped derived means identified that hospital service use varied significantly between AAD and CAD. Whilst AAD accounted for greater attendances than NAD (2.78; 95% CI 2.680-2.879) those with CAD accounted for even greater attendances (4.33; 95% CI. 4.136-4.515), admissions (2.56; 95% CI. 2.502-2.625) and total bed days (15.14; 95% CI. 14.716-15.559). CONCLUSIONS AD place a disproportionate impact on hospital services with CAD exerting the greatest burden on hospital utilization. The complexity and burden of CAD suggests this group should be a priority for intervention.
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Affiliation(s)
- Thomas Phillips
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK.,Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
Thirty percent of emergency department admissions are related to an alcohol misuse. Eighty percent of acute intoxications admitted in emergency departments concern patients with alcohol addiction. Care protocols validated in all of emergency departments are necessary for prevention of alcohol withdrawal syndrome. Risky uses require ultra-brief interventions, situations of abuse (light use disorders) require brief interventions and situations of dependence (moderate to severe use disorders) require motivational interviews to promote the emergence of a process of change. The key word for alcohol intervention in emergencies is: empathy. Search addictive comorbidities (tobacco and cannabis) and psychiatric comorbidities (depression and suicidal risk) must be systematic. The coordination between emergency departments and addictology departments is essential. In the emergency department, the goal is to optimise patient care path for all addictive behaviors.
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Affiliation(s)
- Georges Brousse
- Université Clermont Auvergne 1, UFR médecine, EA7280, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, psychiatrie addictologie B, 63003 Clermont-Ferrand, France.
| | | | - Julien Cabe
- Université Clermont Auvergne 1, UFR médecine, EA7280, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, psychiatrie addictologie B, 63003 Clermont-Ferrand, France
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Schwarz AS, Nielsen B, Nielsen AS. Lifestyle factors in somatic patients with and without potential alcohol problems. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2017; 70:714-723.e13. [DOI: 10.1016/j.annemergmed.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/03/2023]
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Barata IA, Shandro JR, Montgomery M, Polansky R, Sachs CJ, Duber HC, Weaver LM, Heins A, Owen HS, Josephson EB, Macias-Konstantopoulos W. Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review. West J Emerg Med 2017; 18:1143-1152. [PMID: 29085549 PMCID: PMC5654886 DOI: 10.5811/westjem.2017.7.34373] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Alcohol use disorders (AUD) place a significant burden on individuals and society. The emergency department (ED) offers a unique opportunity to address AUD with brief screening tools and early intervention. We undertook a systematic review of the effectiveness of ED brief interventions for patients identified through screening who are at risk for AUD, and the effectiveness of these interventions at reducing alcohol intake and preventing alcohol-related injuries. METHODS We conducted systematic electronic database searches to include randomized controlled trials of AUD screening, brief intervention, referral, and treatment (SBIRT), from January 1966 to April 2016. Two authors graded and abstracted data from each included paper. RESULTS We found 35 articles that had direct relevance to the ED with enrolled patients ranging from 12 to 70 years of age. Multiple alcohol screening tools were used to identify patients at risk for AUD. Brief intervention (BI) and brief motivational intervention (BMI) strategies were compared to a control intervention or usual care. Thirteen studies enrolling a total of 5,261 participants reported significant differences between control and intervention groups in their main alcohol-outcome criteria of number of drink days and number of units per drink day. Sixteen studies showed a reduction of alcohol consumption in both the control and intervention groups; of those, seven studies did not identify a significant intervention effect for the main outcome criteria, but nine observed some significant differences between BI and control conditions for specific subgroups (i.e., adolescents and adolescents with prior history of drinking and driving; women 22 years old or younger; low or moderate drinkers); or secondary outcome criteria (e.g. reduction in driving while intoxicated). CONCLUSION Moderate-quality evidence of targeted use of BI/BMI in the ED showed a small reduction in alcohol use in low or moderate drinkers, a reduction in the negative consequences of use (such as injury), and a decline in ED repeat visits for adults and children 12 years of age and older. BI delivered in the ED appears to have a short-term effect in reducing at-risk drinking.
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Affiliation(s)
- Isabel A. Barata
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jamie R. Shandro
- Harborview Medical Center, University of Washington Medical Center, Department of Emergency Medicine, Seattle, Washington
| | | | - Robin Polansky
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Carolyn J. Sachs
- UCLA David Geffen School of Medicine, Emergency Medicine Center, Los Angeles, California
| | - Herbert C. Duber
- Harborview Medical Center, University of Washington Medical Center, Department of Emergency Medicine, Seattle, Washington
| | - Lindsay M. Weaver
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Alan Heins
- Cullman Regional Medical Center, Department of Emergency Medicine, Cullman, Alabama
| | - Heather S. Owen
- Parkland Memorial Hospital, Department of Emergency Medicine, Dallas, Texas
| | - Elaine B. Josephson
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
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Evaluation of screening and brief intervention for hazardous alcohol use integrated into clinical practice in an inner-city Emergency Department. Eur J Emerg Med 2017; 24:224-229. [DOI: 10.1097/mej.0000000000000320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vilain P, Larrieu S, Mougin-Damour K, Marianne Dit Cassou PJ, Weber M, Combes X, Filleul L. Emergency department syndromic surveillance to investigate the health impact and factors associated with alcohol intoxication in Reunion Island. Emerg Med J 2017; 34:386-390. [PMID: 28188203 DOI: 10.1136/emermed-2015-204987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/14/2016] [Accepted: 12/22/2016] [Indexed: 11/04/2022]
Abstract
In Reunion Island, alcohol is the most tried out psychoactive substance. To our knowledge, few indicators measuring the health burden of alcohol use exist on the island. In this context, an exploratory analysis based on syndromic surveillance data was implemented in order to describe the emergency department (ED) visits for alcohol intoxication (AI) and factors associated with their variations.An analysis of anonymized records routinely collected by the syndromic surveillance system was carried out. A daily indicator of ED visits for AI was built from a selection of ICD-10 codes between 2010 and 2012. Health impact of AI was first described comparing this indicator to all causes ED visits. Then, AI visits were analyzed with time-series methods using generalized additive Poisson regression models allowing for overdispersion. The following variables were included in the model: long-term trend, seasonality, day of the week, public and school holidays, days of festival and minimum social benefits payday.During the study period, 16 652 visits for AI were recorded in EDs of Reunion Island. AI visits were the second reason for ED visits (i.e. 4%) after traumatism. AI visits mainly concerned men (87%) and the age group of 25-54 years (69%). There was a significant increase in ED visits for AI during days of benefits payday, weekends and publics holidays.This study demonstrated the interest of syndromic surveillance to monitor non-infectious diseases. Time-series models showed a robust association between ED visits for AI and several factors.
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Affiliation(s)
- Pascal Vilain
- Regional unit of the French national public health agency in Indian Ocean, Saint-Denis, France
| | - Sophie Larrieu
- Regional unit of the French national public health agency in Indian Ocean, Saint-Denis, France
| | | | | | - Marc Weber
- Department of Emergency, Hospital Centre, Saint-Benoît, France
| | - Xavier Combes
- Department of Emergency, University Hospital Centre, Saint-Denis, France
| | - Laurent Filleul
- Regional unit of the French national public health agency in Indian Ocean, Saint-Denis, France
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Do Alcohol Misuse, Service Utilisation, and Demographic Characteristics Differ between UK Veterans and Members of the General Public Attending an NHS General Hospital? J Clin Med 2016; 5:jcm5110095. [PMID: 27827830 PMCID: PMC5126792 DOI: 10.3390/jcm5110095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022] Open
Abstract
The aim of this paper was to provide insights into alcohol misuse within UK veterans to inform as to whether their presentations differ from the general public. This was done by exploring differences in the severity of alcohol misuse between UK veterans and the general public admitted to a general NHS hospital over an 18 month period using retrospective data. All patients admitted to the hospital were screened for alcohol misuse. Those deemed as experiencing problems were referred for specialist nurse-led support. A total of 2331 individuals were referred for this supported and administered with a standardised assessment that included measures of the severity of alcohol difficulties (AUDIT), dependency levels (LDQ), and assessed for the presence of withdrawal symptoms (CIWA-Ar). In addition, information was collected on service utilisation, referral category (medical or mental health), other substance misuse, and demographic characteristics. No differences were found between the severity of reported alcohol difficulties between veterans and non-veterans. Evidence was found to suggest that veterans were more likely to be referred for support with alcohol difficulties at an older age and to be admitted to hospital for longer periods of time. This could have considerable cost implications for the NHS. It was more common for veterans to present at hospital with physical health difficulties prior to being referred for support for alcohol.
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Schwarz AS, Bilberg R, Bjerregaard L, Nielsen B, Søgaard J, Nielsen AS. Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial. BMC Health Serv Res 2016; 16:132. [PMID: 27080865 PMCID: PMC4832463 DOI: 10.1186/s12913-016-1376-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background A large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model. Method/Design The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used. Discussion We expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures. Trial registration https://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)
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Affiliation(s)
- Anne-Sophie Schwarz
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Randi Bilberg
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lene Bjerregaard
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jes Søgaard
- The Danish Cancer Society and Aarhus University, Faculty of Health Science, Institute of Clinical Medicine, Department of Clinical Epidemiology, Copenhagen, Denmark
| | - Anette Søgaard Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Fulbrook P, Lawrence P, Watt K. Validity of the Paddington Alcohol Test in an Australian Emergency Department. Alcohol Alcohol 2015; 50:407-12. [DOI: 10.1093/alcalc/agv024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/02/2015] [Indexed: 11/14/2022] Open
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McMurran M, Robertson E, Coffey F, Miller P. The profile of risky single occasion drinkers presenting at an Emergency Department. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2012.698694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abreu MSD, Ferreira SDDA, Ferreira LPDL, Toneo Júnior JF, Maciel WV, Maciel SSSV. Prevalence and costs of hospitalizations for poisoning and accidental intoxication in Brazilian elderly. BRAZ J PHARM SCI 2013. [DOI: 10.1590/s1984-82502013000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cross-sectional study of secondary data/information obtained from the Hospital Information System (HIS) spanning the years 2008 - 2009 was performed. The distribution of the main hospital admissions by gender, age, color/race, region and federal unit of residence, average expenditure and average length of hospital stay, year of hospitalization and mortality rates (MR) were studied. The data collected were tabulated by TabNet and keyed into Microsoft Excel 2007. It was verified that elderly males (54.3%), from 60 to 69 years old (50.6%), nonwhites (36.3%) and residents of Southeast and North regions of the country had the highest rates of hospitalization. Seniors were hospitalized for an average of 4.8 days, and the major causes were exposure to alcohol (43.7%) and to drugs (33.9%). Expenses related to hospital admissions were, on average, R$ 529,817.70. The highest mortality rates were recorded among females (MR = 4.34), in elderly, 80 years or older (MR = 10.16) and Caucasians (MR = 3.95), where pharmacological substances with action on the Autonomic Nervous System were the leading cause of death. There are demographic differences in morbi-mortality of these elderly since, although men and younger elderly were the main victims, women and elderly of advanced age have greater mortality. The leading causes of hospitalization were alcohol and drugs.
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Affiliation(s)
| | | | | | | | - Wamberto Vieira Maciel
- Universidade de Pernambuco, Brazil; Associação Caruaruense de Ensino Superior e Técnico, Brazil
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Verelst S, Moonen PJ, Desruelles D, Gillet JB. Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room. Alcohol Alcohol 2012; 47:433-8. [PMID: 22493048 DOI: 10.1093/alcalc/ags035] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS The aim of the study was to describe the epidemiology, management and cost of emergency department (ED) visits due to alcohol intoxication. METHODS A retrospective review of medical records of all episodes of alcohol intoxication was made, excepting those where another diagnosis such as trauma or psychiatric illness was primary, in patients older than 16 years, who presented to the ED of a large university hospital in Belgium over a 12-month period from 1 January 2009. RESULTS A total of 635 such patients accounted for 1.2% of all ED visits; 429 were males and 48.3% were aged between 41 and 60 years; 63.8% of the patients had a history of alcohol use disorder and 60.3% had a history of psychiatric disorder; 74.3% of the patients received some form of medical treatment and 62% were seen by a psychiatrist. Of the total, 57.5% of the patients were admitted to the ED observation ward, with a mean length of stay of 8.4 h. The estimated total cost was €318 838.25, with an average of €541.32 per patient. CONCLUSION Alcohol intoxication leads to a financial burden on the community. In addition to imposing physical, social and psychological stress on the community, the often agitated or aggressive patient imposes stress on ED staff. Close surveillance of trends in alcohol abuse is warranted, and the ED should consider implementing a questionnaire method of screening for alcohol abuse.
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Affiliation(s)
- Sandra Verelst
- Emergency Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Abstract
ISSUES This article traces the history of research on the development, evaluation and implementation of alcohol brief intervention (BI) in Europe. APPROACH Narrative and historical review. KEY FINDINGS BI originated in Europe and, following a definition of opportunistic BI, early pioneering studies are summarised. The role of European scientists in the series of studies making up the WHO Collaborative Project on Detection and Management of Alcohol-related Problems in Primary Health Care (1982-2006) is then described, followed by a short account of a current EU-funded project (Primary Health European Project on Alcohol) with the aim of achieving a widespread, routine and enduring implementation of BI in EU member states. In addition to involvement in these two major projects, a great deal of research on BI has been carried out in a range of European countries and some of this research is noted. IMPLICATIONS Several European governments are now taking the rolling out of BI in routine services very seriously as a policy measure. There is no necessary conflict between widely available BI and alcohol control measures. CONCLUSION While much remains to be done regarding practical implementation, the mood of those interested in the promotion of BI as a means of reducing alcohol-related harm, in Europe as elsewhere, is cautiously optimistic.
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Affiliation(s)
- Nick Heather
- Department of Psychology, School of Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
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Owens L, Butcher G, Gilmore I, Kolamunnage-Dona R, Oyee J, Perkins L, Walley T, Williamson P, Wilson K, Pirmohamed M. A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC). BMC Public Health 2011; 11:528. [PMID: 21726445 PMCID: PMC3141470 DOI: 10.1186/1471-2458-11-528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/04/2011] [Indexed: 12/03/2022] Open
Abstract
Background Alcohol dependence affects approximately 3% of the English population, and accounts for significant medical and psychiatric morbidity. Only 5.6% of alcohol-dependent individuals ever access specialist treatment and only a small percentage ever seek treatment. As people who are alcohol dependent are more likely to have experienced health problems leading to frequent attendance at acute hospitals it would seem both sensible and practical to ensure that this setting is utilised as a major access point for treatment, and to test the effectiveness of these treatments. Methods/Design This is a randomised controlled trial with a primary hypothesis that extended brief interventions (EBI) delivered to alcohol-dependent patients in a hospital setting by an Alcohol Specialist Nurse (ASN) will be effective when compared to usual care in reducing overall alcohol consumption and improving on the standard measures of alcohol dependence. Consecutive patients will be screened for alcohol misuse in the Emergency Department (ED) of a district general hospital. On identification of an alcohol-related problem, following informed written consent, we aim to randomize 130 patients per group. The ASN will discharge to usual clinical care all control group patients, and plan a programme of EBI for treatment group patients. Follow-up interview will be undertaken by a researcher blinded to the intervention at 12 and 24 weeks. The primary outcome measure is level of alcohol dependence as determined by the Severity of Alcohol Dependence Questionnaire (SADQ) score. Secondary outcome measures include; Alcohol Use Disorders Identification Test (AUDIT) score, quantity and frequency of alcohol consumption, health-related quality of life measures, service utilisation, and patient experience. The trial will also allow an assessment of the cost-effectiveness of EBI in an acute hospital setting. In addition, patient experience will be assessed using qualitative methods. Discussion This paper presents a protocol for a RCT of EBI delivered to alcohol dependent patients by an ASN within an ED. Importantly; the trial will also seek to understand patients' perceptions and experiences of being part of a RCT and of receiving this form of intervention. Trial registration number ISRCTN: ISRCTN78062794
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Affiliation(s)
- Lynn Owens
- The Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
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Cobain K, Owens L, Kolamunnage-Dona R, Fitzgerald R, Gilmore I, Pirmohamed M. Brief Interventions in Dependent Drinkers: A Comparative Prospective Analysis in Two Hospitals. Alcohol Alcohol 2011; 46:434-40. [DOI: 10.1093/alcalc/agr044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jane L. How is alcohol withdrawal syndrome best managed in the emergency department? Int Emerg Nurs 2009; 18:89-98. [PMID: 20382370 DOI: 10.1016/j.ienj.2009.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 08/24/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
Abstract
Alcohol abuse is a major cause of morbidity and mortality and subsequently presents a substantial burden on the NHS. Whether presentations are directly or indirectly linked, the emergency department (ED) holds a predominant role in dealing with this matter. Alcohol withdrawal syndrome is a common complication of alcohol misuse. Given its pathophysiology and manifestation of symptoms, early recognition and treatment is paramount in preventing a medical emergency. From a review of the associated literature, a standardised protocol for its management in ED is consequently advocated. This includes: Identification of those at risk via routine screening; Monitoring progression and severity using an alcohol withdrawal scale; Implementation of symptom-triggered therapy on the basis of objective evidence collected. Nonetheless, further studies are required to aid the choice of tools and ascertain the efficacy of such protocols within the ED department. Due to time constraints of this real-world setting, feasibility may be considered as important as reliability and validity if new practices are to be considered.
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Affiliation(s)
- Louise Jane
- Emergency Department, Royal Cornwall Hospital, 49 Manor Close, St. Austell, Cornwall Pl25 4HH, United Kingdom.
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Scott RGA, Keaney F, Marshall EJ, Strang J, Sinha J, Peters TJ. The feasibility of substance misuse screening in referrals from Accident and Emergency to an inner-city fracture clinic: results from a pilot study. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890210132081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Heather N, Dallolio E, Hutchings D, Kaner E, White M. Implementing routine screening and brief alcohol intervention in primary health care: A Delphi survey of expert opinion. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890410001665014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nick Heather
- School of Psychology & Sport Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Emma Dallolio
- Formerly Centre for Alcohol & Drug Studies, Newcastle North Tyneside & Northumberland Mental Health NHS Trust, Newcastle upon Tyne, UK
| | - Deborah Hutchings
- School of Population & Health Sciences, University of Newcastle upon Tyne, UK
| | - Eileen Kaner
- School of Psychology & Sport Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Martin White
- Formerly Centre for Alcohol & Drug Studies, Newcastle North Tyneside & Northumberland Mental Health NHS Trust, Newcastle upon Tyne, UK
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Bisson JI, Mcbride AJ, Christofides SK. Psychiatric problems associated with alcohol in an Accident & Emergency setting. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890215693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lock CA. Screening and brief alcohol interventions: What, why, who, where and when? A review of the literature. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890410001665096] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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INDIG DEVON, COPELAND JAN, CONIGRAVE KM, ROTENKO IRENE. Why are alcohol-related emergency department presentations under-detected? An exploratory study using nursing triage text. Drug Alcohol Rev 2009; 27:584-90. [DOI: 10.1080/09595230801935680] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Touquet R, Brown A. PAT (2009)--revisions to the Paddington Alcohol Test for early identification of alcohol misuse and brief advice to reduce emergency department re-attendance. Alcohol Alcohol 2009; 44:284-6. [PMID: 19329654 PMCID: PMC2670963 DOI: 10.1093/alcalc/agp016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Paddington Alcohol Test (PAT) has evolved over 15 years as a clinical tool to facilitate emergency physicians and nurses giving brief advice and the offer of an appointment for brief intervention by an alcohol nurse specialist. Previous work has shown that unscheduled emergency department re-attendance is reduced by 'making the connection' between alcohol misuse and resultant problems necessitating emergency care. The revised 'PAT (2009)' now includes education on clinical signs of alcohol misuse and advice on when to request a blood alcohol concentration.
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Affiliation(s)
- Robin Touquet
- Accident & Emergency Department, Imperial College Healthcare Trust, St Mary's Hospital Campus, London, UK.
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Castilla-Puentes RC, Secin R, Grau A, Galeno R, Feijo de Mello M, Pena N, Sanchez-Russi CA. A multicenter study of major depressive disorder among emergency department patients in Latin-American countries. Depress Anxiety 2009; 25:E199-204. [PMID: 17979140 DOI: 10.1002/da.20380] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This multicenter study estimated the prevalence of major depressive disorder (MDD) among emergency department patients in Latin America. To identify patients with MDD, we used a combination of DSM IV- criteria interview and a questionnaire screen including the center for Epidemiological Studies Depression Scale. We analyzed data from consecutive adult patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico and described the demographic and health status differences between MDD and non-MDD patients. Prevalence of MDD ranges from 23.0 to 35.0%. The estimates are based on a total of 1,835 patients aged 18 years and over, with response rates of 83.0%. Compared to non-MDD patients, MDD patients were more likely to be middle-aged, female, smokers, of lower socioeconomic status, and to report a diagnosis of asthma or arthritis/rheumatism. Multivariate analysis identified a lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems to be independently associated with MDD. Our data suggest that the prevalence of MDD is elevated among emergency department patients in Latin American countries. The integration of depression screening into routine emergency care merits serious consideration, especially if such screening can be linked to psychiatric treatment.
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Affiliation(s)
- Ruby C Castilla-Puentes
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Nilsen P, Baird J, Mello MJ, Nirenberg T, Woolard R, Bendtsen P, Longabaugh R. A systematic review of emergency care brief alcohol interventions for injury patients. J Subst Abuse Treat 2008; 35:184-201. [DOI: 10.1016/j.jsat.2007.09.008] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/22/2007] [Accepted: 09/30/2007] [Indexed: 10/22/2022]
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Csipke E, Touquet R, Patel T, Franklin J, Brown A, Holloway P, Batrick N, Crawford MJ. Use of blood alcohol concentration in resuscitation room patients. Emerg Med J 2007; 24:535-8. [PMID: 17652671 PMCID: PMC2660072 DOI: 10.1136/emj.2006.045583] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To clarify the use of blood alcohol concentration (BAC) in the emergency department resuscitation room, by comparing it with a subsequent alcohol questionnaire and by surveying patients' attitudes to BAC testing. DESIGN Observational study. PARTICIPANTS 273 resuscitation room patients at St Mary's Hospital, Paddington between August 2005 and February 2006. MAIN OUTCOME MEASURES BAC comparison to questionnaire results, and attitudes to BAC testing. RESULTS The level of agreement between positive screening by questionnaire and a BAC of >80 mg/100 ml was low (kappa = 0.29, 95% confidence interval 0.12 to 0.46) because each test measures different aspects of drinking. Patients accepted the use of BAC tests in detecting alcohol use, though a small minority reported concerns over confidentiality. CONCLUSION Use of BAC testing complements later questionnaire screening to identify alcohol misuse in patients initially brought to the emergency department resuscitation room, providing results are fed back to the patient. Potential ethical, judicial and insurance concerns should not prevent the use of BAC when judged to be in the patient's best interest.
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Affiliation(s)
- Emese Csipke
- Accident and Emergency Department, St Mary's Hospital, Praed Street, London, UK
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Abstract
AIMS To investigate the problem of children presenting to hospital with alcohol intoxication. METHODS An observational study was conducted over 18 months profiling children who presented to hospital with acute alcohol intoxication, proved by laboratory tests on blood alcohol levels (BALs). The study was part of a multicentre-funded injury prevention project based on the widely accepted Canadian Hospital Injury Reporting and Prevention Programme. RESULTS 62 children (31 boys), mean age 14.5 years, presented with alcohol intoxication proved by BALs. The mean BAL was 203 mg/dl (standard deviation (SD) 80.7). As a point of reference, 56 (90%) children had BAL above the UK legal driving limit of 80 mg/dl. The most common type of alcohol consumed was spirits, in the form of whisky, gin, vodka and tequila. No significant association was seen between age and BAL. Children with high alcohol levels were much more likely to have lower Glasgow Coma Scores (p<0.001), but in contrast with conventional teaching, there was no association between blood glucose levels and BALs. The median Glasgow Coma Score on admission to the emergency department was 12. 15 (24%) children had a score < or = 8/15. Injuries were present in 21 (34%) children, most of which were minor injuries. Minor head injury was most common, accounting for 42% of the injuries. The most common cause of injury was a fall. DISCUSSION The results of this study confirm the heavy use of alcohol by some young children. This highlights a definite problem, which needs to be dealt with by a variety of measures, giving particular consideration to the ease of access to alcohol by children.
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Affiliation(s)
- L Weinberg
- Department of Anaesthetics, Austin Health, Heidelberg, Victoria, 3084, Australia.
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Touquet R, Brown A. Alcohol misuse: positive response. Alcohol Health Work for every acute hospital saves money and reduces repeat attendances. Emerg Med Australas 2006; 18:103-7. [PMID: 16669934 DOI: 10.1111/j.1742-6723.2006.00834.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roche AM, Freeman T, Skinner N. From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption. Drug Alcohol Depend 2006; 83:1-14. [PMID: 16310323 DOI: 10.1016/j.drugalcdep.2005.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 10/18/2005] [Accepted: 10/18/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To conduct a systematic review of hospital alcohol screening studies to identify effective and efficient evidence-based strategies. METHOD Sixty-five studies (N=100,980) of alcohol problem prevalence amongst hospital patients were reviewed. RESULTS Prevalence of positive alcohol screens varied according to hospital location, screening tool and patient characteristics. BAC measures (26%) were nearly twice as likely (OR=1.92, p<.001) to reveal positive screens in the ED than self-reports (16%). No difference was found in prevalence of self-report positive screens between ED (16%) and ward settings (17%). Males were two to four times more likely than females to screen positive (BAC: OR=2.37, p<.001, ED self-report: OR=3.07, p<.001, ward self-report: OR=4.30, p<.001). ED patients aged 20-40 years and ward patients aged 30-50 years had the highest prevalence of positive screens. CONCLUSIONS Prevalence of risky or problematic drinking among hospital patients is high and warrants systematic screening and intervention. Many hospitals lack sufficient resources to undertake widespread screening programs. For optimum return on resources, it is recommended to screen males in the ED using BAC measures. Established protocols applying priority criteria and staff training can increase screening accuracy and effectiveness.
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Affiliation(s)
- Ann M Roche
- National Centre for Education and Training on Addiction, Flinders University, South Australia, GPO Box 2100, Adelaide, SA 5001, Australia.
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Williams S, Brown A, Patton R, Crawford MJ, Touquet R. The half-life of the 'teachable moment' for alcohol misusing patients in the emergency department. Drug Alcohol Depend 2005; 77:205-8. [PMID: 15664722 DOI: 10.1016/j.drugalcdep.2004.07.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 07/23/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND To determine whether the length of time between alcohol-related attendance in the emergency department (ED) and follow-up appointment with an alcohol health worker (AHW) alters attendance rate at the AHW clinic. METHODS We examined paper and computerized records made by AHWs over a 4-year period, collecting data on the length of time between identification of alcohol misuse and the appointment with the AHW, and whether the appointment was kept. RESULTS There is an inverse relationship between the length of time between identification of alcohol misuse and AHW appointment and the subsequent likelihood of keeping that appointment. CONCLUSIONS To maximise attendance rates at AHW clinics, the delay between the identification and intervention for alcohol misusing patients must be kept to a minimum, preferably giving an appointment on the same day as the attendance in the ED.
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Affiliation(s)
- Sean Williams
- Department of Accident and Emergency Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
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Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, Reece B, Brown A, Henry JA. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet 2004; 364:1334-9. [PMID: 15474136 DOI: 10.1016/s0140-6736(04)17190-0] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alcohol misuse is highly prevalent among people attending emergency departments, but the effect of intervention by staff working in these departments is unclear. We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department. METHODS We undertook a single-blind pragmatic randomised controlled trial. Patients received either an information leaflet or an information leaflet plus an appointment with an alcohol health worker. Outcome data were collected by patient interview and examination of hospital records at 6 and 12 months. FINDINGS 599 patients were randomised over a 12-month period. At 6 months, those referred to an alcohol health worker were consuming a mean of 59.7 units of alcohol per week compared with 83.1 units in the control group (t -2.4, p=0.02). At 12 months those referred were drinking 57.2 units per week compared with 70.8 in controls (t -1.7, p=0.09). Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the emergency department over the following 12 months (1.2 compared with 1.7, t -2.0, p=0.046). Differences in quality of life were not found. INTERPRETATION Opportunistic identification and referral for alcohol misuse in an emergency department is feasible, associated with lower levels of alcohol consumption over the following 6 months, and reduces reattendance at the department. Short-term reductions in alcohol consumption associated with referral for brief intervention for alcohol misuse benefit patients and reduce demand for accident and emergency department services.
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Affiliation(s)
- Mike J Crawford
- Department of Psychological Medicine, Imperial College, London, UK.
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Aalto M, Seppä K. USEFULNESS, LENGTH AND CONTENT OF ALCOHOL-RELATED DISCUSSIONS IN PRIMARY HEALTH CARE: THE EXIT POLL SURVEY. Alcohol Alcohol 2004; 39:532-5. [PMID: 15351746 DOI: 10.1093/alcalc/agh090] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate patients' opinions of the usefulness of alcohol-related discussions with general practitioners (GPs), the time used for the discussion and its main content. METHODS Exit poll survey to 2000 consecutive patients right after GP consultations. RESULTS The response rate was 60.2% (1203/2000). Of the patients 11.6% (139/1203) reported that they were asked and/or advised about alcohol during the consultation. The time used for discussion about alcohol was mostly <4 min; longer for heavy than for non-heavy drinkers. Main topics of the discussion dealt with quantities consumed and harm caused by alcohol. The majority of the patients (81%) reported that discussions concerning alcohol were useful. In that respect heavy drinkers did not differ from non-heavy drinkers. CONCLUSIONS Discussions about alcohol in primary health care were rare and short, but patients' opinions about their usefulness were mainly positive.
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Affiliation(s)
- Mauri Aalto
- Department of Mental Health and Alcohol Research, National Public Health Institute, PO Box 33, FIN-00251 Helsinki, Finland.
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