Emergency Department Screening for Unhealthy Alcohol and Drug Use with a Brief Tablet-Based Questionnaire

Abstract

Background. Screening for unhealthy alcohol and drug use in the emergency department (ED) can be challenging due to crowding, lack of privacy, and overburdened staff. The objectives of this study were to determine the feasibility and utility of a brief tablet-based screening method in the ED and if patients would consider a face-to-face meeting with a certified alcohol and drug counselor (CADC) for more in-depth screening, brief intervention, and referral to treatment (SBIRT) helpful via this interface. Methods. A tablet-based questionnaire was offered to 500 patients. Inclusion criteria were age ≥18, Emergency Severity Index 2–5, and English comprehension. Subjects were excluded if they had evidence of acute intoxication and/or received sedating medication. Results. A total of 283 (57%) subjects were enrolled over a 4-week period, which represented an increase of 183% over the monthly average of patients referred for SBIRT by the CADC prior to the study. There were 131 (46%) who screened positive for unhealthy alcohol and drug use, with 51 (39%) and 37 (28%) who screened positive for solely unhealthy alcohol use and drug use/drug use disorders, respectively. There were 43 (33%) who screened positive for combined unhealthy alcohol and drug use. Despite willingness to participate in the tablet-based questionnaire, only 20 (15%) with a positive screen indicated via the tablet that a face-to-face meeting with the CADC for further SBIRT would be helpful. Conclusion. Brief tablet-based screening for unhealthy alcohol and drug use in the ED was an effective method to increase the number of adult patients identified than solely by their treating clinicians. However, only a minority of subjects screening positive using this interface believed a face-to-face meeting with the CADC for further SBIRT would be helpful.

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use

“…Educational programs provided by SAMHSA, the National Association of Addiction Treatment Providers (NAATP), the American Society of Addiction Management (ASAM), and multiple other organizations can help clinicians break down the biases that can lead to stigmatizing behaviors. Technologybased screening is preferable for many due to the anonymity that eases the perception of stigma associated with a disclosure of HAU (Elder et al, 2020;Hammock et al, 2020).…”

“…HAU (Mojica-Perez et al, 2019). Another study in this review found that patients were more willing to complete alcohol use screening utilizing a tablet-based method as an alternative to a face-to-face encounter with a health care provider (Elder et al, 2020). The researchers administered the tablet-based questionnaire to 283 emergency department (ED) patients, and 46% of the participants were found to have unhealthy alcohol use.…”

“…The tablet-based administration increased response rates by 131%. Of note, most of the study participants with a positive screen were not interested in receiving brief counseling interventions (Elder et al, 2020).…”

“…Layepidemiology undermines public health approaches to provide accurate messages regarding alcohol consumption guidelines (Lovatt et al, 2015). There is strong evidence to support SBI; however, patients report less confidence in the effectiveness of alcohol counseling (Elder et al, 2020;O'Donnell et al, 2020;Taylor et al, 2016). Lay epidemiology can also influence a provider's views and practices regarding SBI.…”

Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for I-COPE study

“…Eligible patients receive a pre-visit questionnaire that asks about pain symptoms, goals for pain management, pain treatment preferences, depression symptoms, and opioid and illicit drug use (Additional file 3 ). The questionnaire uses validated screeners to ask about current levels of pain (Pain, Enjoyment of Life, General Activity (PEG) scale), depression (PHQ-2), and drug use (drug abuse screening test (DAST-2) (ACCESS) or single-question drug use screener (UCM)) [ 13 – 15 ]. The I-COPE questionnaire also asks patients to identify functional goals that might be achieved through better pain management, and treatment preferences ranging from self-management to surgical intervention.…”