Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients

Abstract

ImportanceAlcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden.ObjectiveTo compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking.Design, Setting, and ParticipantsThis bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020.InterventionPatients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up.Main Outcomes and MeasuresThe primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization.ResultsAmong 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction).Conclusions and RelevanceIn this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities.Trial RegistrationClinicalTrials.gov Identifier: NCT02247388

Bilingual Care in Clinical Trials—Understanding the Need for Expanded Research in Latino Communities

“…It has been reported that patients with limited English language proficiency experience high rates of medical errors and worse clinical outcomes compared with English-speaking patients . The current study by Vaca et al is a leader in introducing problems related to the Latino community and AUDs, but it opens exploration to other potential research topics addressing how the Latino community has been affected by AUDs. Patients with AUDs can have comorbidities, such as cirrhosis, which can eventually develop into hepatocellular carcinoma, for which the treatment is often a liver transplant.…”

“…The article by Vaca et al provides the results of a randomized clinical trial investigating the use of a bilingual alcohol screening tool vs standard care to reduce high-risk alcohol consumption in Latino ED patients. The authors that found those who received the trial intervention had significantly fewer binge drinking episodes within the last 28 days at 12 months after randomization. In addition, Latino participants more often preferred to use the bilingual tool in the Spanish language.…”

“…This lack of access to care is associated with social and cultural factors, such as stigma and language barriers, and highlights the need for culturally appropriate and accessible treatment options for Latino individuals with AUDs. The present work by Vaca et al helps to address this problem because AB-CASI is a tool that can increase connection and access to alcohol treatment in Hispanic and Latino communities.…”

“…The study’s limitations include a concern about the population studied, 83% of whom were of Puerto Rican descent . This factor showed the effectiveness of interventions like AB-CASI in Puerto Rican populations, but further validation research across other cultures and Latino populations is needed to assess the benefit of this tool as a universal bilingual care standard (ie, persons of Cuban, Mexican, Salvadorian, and other Latino ethnicity may respond differently to this tool).…”

“…The study by Vaca et al demonstrated how the sole use of a bilingual tool, which asks someone in their native language a question that perhaps they may be asking themselves, can change a person’s behavior. It is almost as if, during the moment they are reading in their native language, they feel heard.…”