Elsevier

The Lancet

Volume 364, Issue 9442, 9–15 October 2004, Pages 1334-1339
The Lancet

Articles
Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial

https://doi.org/10.1016/S0140-6736(04)17190-0Get rights and content

Summary

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.

Published online September 28, 2004 http://image.thelancet.com/extras/04art1389web.pdf

Introduction

Over 14 million people a year are treated in emergency departments (EDs) in England.1 In view of the strong association between alcohol misuse and health related problems such as accidental injury and violence, it is not surprising that alcohol misuse is more prevalent among people attending EDs than among the general population. As many as one in three attendees have consumed alcohol immediately before their presentation, and more than two-thirds of attendances after midnight may be alcohol related.2

Descriptive studies of people offered brief interventions for alcohol misuse in EDs suggest that such interventions might be of benefit.3 However, EDs are busy environments with high patient turnover—these and other factors make intervention in this setting a difficult task. A previous attempt to do a randomised trial in an ED was abandoned due to low levels of screening and uptake of interventions.4 In later studies, investigators have attempted to overcome these problems by deploying trained researchers in an ED to screen patients and deliver interventions.5, 6 Findings of these studies have demonstrated the efficacy of brief interventions, but not the effectiveness. The effect of screening and referral by ED staff has not been investigated in a randomised trial. We therefore aimed to assess the effect of this intervention on alcohol consumption, reattendance at the ED, and quality of life. We used a pragmatic approach to investigate the effects of a form of screening and intervention that has been successfully incorporated into routine clinical practice.

Section snippets

Patients

We conducted a single blind, pragmatic randomised controlled trial among patients attending St Mary's Emergency Department between March, 2001 and April, 2002. St Mary's Hospital serves an inner London population of 450 000 residents that are on average younger, more mobile, and more ethnically diverse than in other parts of Britain.7 Patients were selectively screened for alcohol misuse as part of routine practice in the department, which involves ED doctors screening patients at the end of

Results

The trial profile is shown in the figure. Most of those who did not meet inclusion criteria either requested to see an alcohol health worker or resided outside Greater London. 468 (78·1%) of the patients randomised were male, and ages ranged from 18 to 90 years (mean 44 years). Characteristics of patients randomised to the control and experimental treatment groups are presented in table 1.

At 6-month follow up, 363 interviews were completed. Additional resources enabled us to complete 384

Discussion

Our findings show that in people who were identified as misusing alcohol while attending an ED, referral for brief intervention was associated with lower alcohol consumption at 6 months compared with the simple provision of a health information leaflet. Alcohol consumption was also lower in the experimental group at 12 months, but the difference was no longer significant due to a fall in alcohol consumption among controls. This finding contrasts with other studies of brief intervention, in

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