What makes emergency department patients reduce their alcohol consumption? – A computer-based intervention study in Sweden

Trinks, Anna; Festin, Karin; Bendtsen, Preben; Nilsen, Per

doi:10.1016/j.ienj.2011.11.004

Cited by 15 publications

(19 citation statements)

References 31 publications

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“…Primary care has a more established role in providing preventive lifestyle interventions including diet and smoking, which may increase the legitimacy of alcohol SBI for both practitioners and patients. Patients often present to ED at a point of crisis which may be accompanied by distress and/or alcohol intoxication, and this might limit patients' receptiveness to alcohol or other lifestyle interventions [28], [29].…”

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

et al. 2014

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BackgroundAlcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial.Methods and FindingsPragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings.ConclusionsSBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions.Trial RegistrationCurrent Controlled Trials ISRCTN 93681536

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Section: Discussionmentioning

confidence: 99%

“…Alternatively it is possible that patients make this connection by virtue of the distress of their presenting condition and having to attend ED, without it being pointed out by clinical staff, which might obviate the need for, and limit the potential impact of SBI [28], [29].…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

et al. 2014

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“…Sex-specific approaches might include substance-only interventions versus those integrating mental health or other problems, 45 such as violence involvement or sexual risk behaviors; 46 different styles of brief interventions, e.g., confrontational versus nonconfrontational; 47 or targeting specific periods of receptivity to behavior change messages, e.g., during pregnancy for women. 48 Digital technologies for delivering SBIRT in the ED are increasingly being studied; 49,50 further work is needed to see how these might optimize the gender-specific approach to alcohol interventions.…”

Section: Consensus Research Agendamentioning

confidence: 99%

A Research Agenda for Gender and Substance Use Disorders in the Emergency Department

et al. 2014

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For many years, gender differences have been recognized as important factors in the etiology, pathophysiology, comorbidities, and treatment needs and outcomes associated with the use of alcohol, drugs, and tobacco. However, little is known about how these gender-specific differences affect ED utilization; responses to ED-based interventions; needs for substance use treatment and barriers to accessing care among patients in the ED; or outcomes after an alcohol-, drug-, or tobacco-related visit. As part of the 2014 Academic Emergency Medicine consensus conference on “Gender-Specific Research in Emergency Care: Investigate, Understand and Translate How Gender Affects Patient Outcomes,” a breakout group convened to generate a research agenda on priority questions related to substance use disorders.

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“…Patients showing evidence of alcohol harm, both acute and chronic, are more prevalent in the ED population than in the general population . Recent data show that 14% of patient presentations to Australian EDs were alcohol related .…”

Section: Introductionmentioning

confidence: 99%

Review article: Effectiveness of ultra‐brief interventions in the emergency department to reduce alcohol consumption: A systematic review

McGinnes

Hutton

Weiland

et al. 2016

Emerg Medicine Australasia

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To assess the effectiveness of ultra-brief interventions (ultra-BI) or technology-involved preventive measures in the ED to reduce alcohol harm and risky drinking. Medline, Embase, PsycINFO, CINAHL and EBM reviews were searched for articles published between 1996 and 2015. Randomised controlled trials and quasi-randomised trials, which compared an ultra-BI with screening, standard care or minimal intervention for adults and adolescents at risk for alcohol-related harm presenting to an ED, were included. Outcomes of interest were frequency of alcohol consumption, quantity of alcohol consumed, binge drinking and ED representation. Thirteen studies (nine single centre and four multicentre) were included. Six studies showed a significant reduction in the quantity consumed with intermediate effect size at 3 months (d = -0.40) and small effect size at 12 months (d = -0.15). Two studies showed a significant reduction in binge drinking with small effect size at 3 months (d = -0.12) and 12 months (d = -0.09). No studies showed an effect on frequency of alcohol consumption or ED representation. Heterogeneity in study design, definition of risky, harmful or hazardous alcohol use, intervention types, outcomes, outcome timeframes and outcome measures prevented the performance of quantitative meta-analysis. Despite its limited effectiveness in reducing alcohol use in the short-term, with the large number of people attending EDs with risky drinking, the use of an effective ultra-BI would have the potential to have a measurable population effect.

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What makes emergency department patients reduce their alcohol consumption? – A computer-based intervention study in Sweden

Cited by 15 publications

References 31 publications

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

A Research Agenda for Gender and Substance Use Disorders in the Emergency Department

Review article: Effectiveness of ultra‐brief interventions in the emergency department to reduce alcohol consumption: A systematic review

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