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Alcohol screening and simple advice in emergency care: staffs’ attitudes and injured patients’ drinking pattern
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: About 800,000 people are risky drinkers in Sweden and the alcohol consumption has increased around 30% during the last 6 years. In order to counteract the negative effects of drinking there is a need to implement preventive measures at various levels in society. One place where risky drinkers could be identified is the healthcare setting. More than 10% of the visits at emergency departments and 20% of the injuries have been found to be alcohol‐related. So far, very few risky drinkers attending emergency departments receive advice about sensible drinking although there is good research evidence of the efficacy of such advice. Aim: The main aim was to explore the effects of a simple alcohol preventive routine in emergency care on staffs´ attitudes towards alcohol prevention and injury patients´ drinking pattern. Material and methods: A screening and simple advice routine was introduced at the emergency department of Motala County hospital. The staffs´ attitudes were explored by interviews with 12 staff members before the introduction and in 6 follow‐up interviews after a year. All the triage staffs´ attitudes were also measured by a questionnaire before the start of the routine and after 6 months. During the first 6 months of the routine 878 injury patients between 16 and 70 completed an alcohol screening questionnaire. During the next 6 months 647 patients received written advice about sensible drinking after having completed the screening questionnaire. A total of 619 patients included in the 12 months study period were followed‐up by telephone interview and changes in drinking pattern were analyzed. After a further 6 months of intervention a total of 2151 patients had been completing the questionnaire during the total study period of 18 months. The association between drinking pattern and different injury variables was analyzed in order to identify special risk groups and situations. Results: The staff was generally positive to alcohol prevention before the routine started and it was completed as intended. After 6 months of screening the staffs´ role legitimacy and perceived skills had increased. Despite of a further positive change in attitudes towards alcohol prevention the staff was uncertain after the study period whether emergency departments are appropriate settings for alcohol prevention. A total of 9% of the women and 31% of the men attending the emergency department for an injury were defined as risky drinkers. One single item in the questionnaire, concerning frequency of heavy episodic drinking, identified the majority of risky drinkers. In the cohort of patients,who was only screened, 34% was no longer engaged in heavy episodic drinking after 6 months and in the cohort that received written advice in addition to the screening the proportion was 25%. The latter group also increased readiness to change by 14%. The proportion of risky drinkers was higher among injury patients, 21% compared to 15% in the general population in the cathment area. This was mostly explained by a higher proportion of young men in the study group. When drinking pattern was compared, both risky and non‐risky drinkers proved to be significantly more likely than abstainers to be injured in amusement locations, parks, lakes or seas and during play or other recreational activities, when controlling for age and sex. Nine percent of the injury patients reported that they believed that their injury was related to alcohol. Half of this group was non risky‐drinkers. Conclusions: The triage staff performed the intervention as agreed, and in some aspects, which could facilitate further development of alcohol preventive measures, their attitudes changed positively. However, it appears difficult to expect alcohol preventive measures to involve more of the staff’s time than the routine tried, and other practical solutions have to be evaluated. A question about frequency of heavy episodic drinking identified the majority of risky drinkers and could be used as a single screening question. There was a reasonable reduction in heavy episodic drinking among the injury patients. The lack of a control group makes it difficult to fully explain whether this change is a result of the injury per se, the screening and the written advice procedure or a natural fluctuation in the patients´ drinking pattern. More studies are needed in order to establish the minimal levels of intervention in routine care that is accepted by the staff, and has a reasonable effect on risky drinkers’ alcohol consumption.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle , 2005.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 928
Keyword [en]
Emergency department, alcohol prevention, screening, simple advice, staff, attitudes, injury
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-5440ISBN: 91-85497-62-2 (print)OAI: oai:DiVA.org:liu-5440DiVA: diva2:21319
Public defence
2005-12-16, Aulan, Hälsans hus, Universitetssjukhuset, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2006-01-16 Created: 2006-01-16 Last updated: 2009-03-06
List of papers
1. Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication
Open this publication in new window or tab >>Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication
2005 (English)In: Public Health, ISSN 0033-3506, Vol. 119, no 9, 789-791 p.Article in journal (Refereed) Published
Keyword
Physicians' attitudes; Routine alcohol screening; Prevention of alcohol problems; Emergency department
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13756 (URN)10.1016/j.puhe.2004.10.008 (DOI)
Available from: 2006-01-16 Created: 2006-01-16
2. Attitude changes among emergency department triage staff after conducting routine alcohol screening
Open this publication in new window or tab >>Attitude changes among emergency department triage staff after conducting routine alcohol screening
2006 (English)In: Addictive Behaviors, ISSN 0306-4603, Vol. 31, no 2, 191-202 p.Article in journal (Refereed) Published
Abstract [en]

Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine.

Keyword
Nurses; Medical secretaries; Attitude change; Emergency department; Obstacles to screening; Role legitimacy; Routine screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13757 (URN)10.1016/j.addbeh.2005.04.021 (DOI)
Available from: 2006-01-16 Created: 2006-01-16
3. Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire
Open this publication in new window or tab >>Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire
2004 (English)In: Drug and Alcohol Dependence, ISSN 0376-8716, Vol. 74, no 1, 71-75 p.Article in journal (Refereed) Published
Abstract [en]

A questionnaire including the three AUDIT-C items was used to screen for alcohol use among trauma patients. The aim was to display, in a pragmatic way, how the AUDIT-C scores can be converted into different levels and kind of risky drinking. Using AUDIT-C scores with a cut-off score of 4 points for women and 5 for men indicated that 28% of the women and 40% of the men were risky drinkers. When calculating weekly alcohol consumption from the answers in AUDIT-C, 3% of the women and 7% of the men were hazardous and/or harmful drinkers. Regarding heavy episodic drinking 7% of the women and 30% of the men was drinking 72 g alcohol or more at on at least one occasion a month. These results indicate that the AUDIT-C score as such give little information about the pattern of alcohol consumption and that evaluation of risky drinking must be calculated from the three items in order to differentiate between risky drinking in terms of alcohol consumed per week and heavy episodic drinking.

Keyword
AUDIT-C, Increased-risk drinking, Screening, Emergency department, Alcohol consumption
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13758 (URN)10.1016/j.drugalcdep.2003.11.010 (DOI)
Available from: 2006-01-16 Created: 2006-01-16
4. Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients?
Open this publication in new window or tab >>Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients?
2005 (English)In: Alcohol & Alcoholism, ISSN 0735-0414 (print) 1464-3502 (online), Vol. 40, no 5, 401-408 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Emergency care patients have an overrepresentation of risky drinkers. Despite the evidence on the effectiveness of a short feedback on screening or self-help material, most studies performed so far have required considerable time from staff and thus been difficult to implement in the real world. The present study evaluates the effect of the screening and whether simple written advice has any additional effect on risky drinking.

Methods: An alcohol screening routine was implemented among injury patients in a Swedish emergency care department. Over 12 months, two cohorts were invited to answer an alcohol screening questionnaire in the waiting room. In the first 6 months, 771 patients were screened without any written advice (cohort A) and in the following 6 months, 563 were screened and in addition received simple written advice about sensible drinking (cohort B). None of the patients received one-to-one feedback. Six months after the screening, a follow-up interview by telephone explored the changes in drinking.

Results: In cohort A 182 (24%) of the patients were defined as risky drinkers and in cohort B 125 (22%). Reached at follow-up after 6 months were 81 (44%) risky and 278 (47%) non-risky drinkers in cohort A, and 40 (32%) risky and 220 (50%) non-risky drinkers in cohort B. The number of patients with heavy episodic drinking decreased significantly in cohort A from 76 (94% of the risky drinkers) to 49 (59%). In cohort B a similar change was seen from 37 (92%) to 27 (68%). Only in cohort B, was a significant increase in readiness to change drinking habits seen [from 3 (8%) to 9 (23%)]. The reduction in heavy episodic drinking was comparable with previous reports from more extensive interventions. However, at the time of follow-up, drinking among non-risky drinkers at baseline had increased. When considering the greater numbers of non-risky drinkers, the total consumption in the study group increased during the study period.

Conclusions: Owing to the reported difficulties of integrating more time-consuming alcohol interventions in emergency departments, it is suggested that at least screening for drinking should be implemented as routine in emergency departments. More research is needed in order to establish the optimal balance between effective alcohol intervention, and acceptable time and effort requirement from staff.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13759 (URN)10.1093/alcalc/agh175 (DOI)
Available from: 2006-01-16 Created: 2006-01-16 Last updated: 2009-05-28
5. Usual drinking pattern and non‐fatal injury among patients seeking medical care
Open this publication in new window or tab >>Usual drinking pattern and non‐fatal injury among patients seeking medical care
Show others...
2006 (English)In: Public Health, ISSN 0033-3506, Vol. 120, no 11, 1064-1073 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

To explore the association between drinking patterns, irrespective of whether alcohol was consumed in the event of the injury or not, and different injury variables; and to identify settings and situations in which risky drinkers have an increased likelihood of injury.

Study design

The study population consisted of all patients aged 18–70 years registered for an injury according to ICD-10 at a Swedish emergency department during an 18-month period. After informed consent, the injury patients were screened for drinking habits by the AUDIT-C questionnaire. The gender, age and drinking pattern of injury patients were compared with the general population.

Methods

A total of 2782 patients aged 18–70 years were registered for an injury during the study period. The number of drop-outs was 631. Drop-outs include those who did not consent to participate, were severely injured, too intoxicated or did not fill out the questionnaire satisfactory. Thus, 77.3% of the target group were included for further analysis (1944 drinkers and 207 abstainers). The patients were categorized into three drinking categories: abstainers, non-risky and risky drinkers. Risky drinkers were defined according to usual weekly consumption of 80 g or more of alcohol for women and 110 g or more for men and/or heavy episodic drinking (i.e. having six glasses or more one glass=12 g alcohol), or both, on one occasion at least once a month, valid for both women and men. To estimate the relationship between drinking patterns and the injury variables (environment, cause of injury, activity and diagnosis), odds ratios (OR) were calculated by logistic regression. Multiple logistic regression was used in order to control for age and sex differences between the various drinking and injury categories.

Results

The proportion of risky drinkers was higher in the study population compared with the general population in the same area. When controlling for age and sex, risky drinkers (OR 6.4adj Confidence interval CI 1.9–21.2) and non-risky drinkers (OR .4.5adj CI 1.4–14.5) displayed an increased risk for injury compared with abstainers, in amusement locations, parks, by or on lakes or seas, especially while engaged in play, hobby or other leisure activities (risky drinkers: OR 2.8adj CI 1.3–5.6; non-risky drinkers: OR 2.4adj CI 1.2–4.6). All differences between drinking patterns in external cause of injury disappeared when age and sex were considered. During rest, meals and attending to personal hygiene, the non-risky drinkers had a lower probability of injury compared with abstainers (OR 0.3adj CI 0.1–0.8). Non-risky drinkers had a higher probability than abstainers of suffering luxation (dislocation) or distortion (OR 1.6adj CI 1.1–2.5). Nine per cent of the study population reported that they believed that their injury was related to intake of alcohol. Half of this group were non-risky drinkers (CI for the 13.7% difference was 9.7–17.6).

Conclusions

Few significant associations between drinking pattern and injury remained when age and sex were controlled for.

Keyword
Usual alcohol drinking patterns; Non-fatal injury; Risky drinkers; Emergency care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13760 (URN)10.1016/j.puhe.2006.06.007 (DOI)
Available from: 2006-01-16 Created: 2006-01-16 Last updated: 2009-05-28

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