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Home > The impact of screening, brief intervention and referral for treatment in emergency department patients’ alcohol use: A 3-, 6- and 12-month follow-up.

Findings. [Findings] The impact of screening, brief intervention and referral for treatment in emergency department patients’ alcohol use: A 3-, 6- and 12-month follow-up. (28 Feb 2011)

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A few minutes with specially hired interventionists can curb the intake of heavy-drinking emergency patients, but in routine practice hospital staff will usually have to do this work. A US study tested this real-world scenario and found the modest drinking reductions were short-lived.

Summary: Set in US emergency departments, this report investigates whether short-term (three months) drinking reductions among risky drinkers exposed to a brief alcohol intervention (reported earlier in Findings) would be sustained over the following nine months, a year in total since the intervention. The elements of the intervention – screening, brief intervention, and (if appropriate) referral for treatment – make the acronym SBIRT, which together with its emergency department setting formed the acronym for the study – ED SBIRT.

For the study, patients whose responses to a seven-question screening survey administered by research staff indicated that they were drinking above US national low-risk guidelines Men, more than 7 UK units (each unit is 8gm alcohol) in a day and no more than 24.5 in a week; women, no more than 5.25 units in a day and no more than 12.25 in a week. were recruited from 14 sites nationwide. Following screening, at each site these patients were sequentially allocated to form a comparison (or 'control') A group of people, households, organisations, communities or other units who do not participate in the intervention(s) being evaluated. Instead, they receive no intervention or none relevant to the outcomes being assessed, carry on as usual, or receive an alternative intervention (for the latter the term comparison group may be preferable). Outcome measures taken from the controls form the benchmark against which changes in the intervention group(s) are compared to determine whether the intervention had an impact and whether this is statistically significant. Comparability between control and intervention groups is essential. Normally this is best achieved by randomly allocating research participants to the different groups. Alternatives include sequentially selecting participants for one then the other group(s), or deliberately selecting similar set of participants for each group. group simply given a list of local referral options, or to the SBIRT intervention. SBIRT patients received the same handout plus the 'Brief Negotiated Interview' intended to reduce unhealthy alcohol use. Based on motivational interviewing, during this highly scripted session lasting on average eight minutes, specially trained emergency department staff first fed back to the patient the results of the screening tests and expressed concern at their risky drinking, then sought to enhance motivation to cut back using motivational techniques such as exploring the pros and cons of drinking as the patient sees them, and reframing and reflecting back to the patient some of their own responses. The session was planned to end with the patient signing an agreement committing them to the drinking goals decided during the preceding discussion, and with referral to primary care or alcohol services as appropriate.

Main findings:
Follow-up surveys were conducted three, six and 12 months later by telephone using an interactive voice response system. 8908 patients were approached at the sites and 7751 agreed to be screened. Of these, 2051 exceeded low-risk limits and 1132 (55% of the identified risky drinkers) agreed to join the study and were enrolled. Of these, 62% completed the three-month follow-up survey, 50% at six months and 38% at 12.

At three months there was a clear impact of the intervention. After adjusting for differences between the groups and estimating Because of these etimates results differ slightly from those previously reported. probable outcomes for patients who could not be followed up, patients allocated to the intervention reported consuming just over five UK units Three US standard drinks or 42gm alcohol. less per week than controls, and the maximum number of drinks per occasion was one and a third UK units 0.76 US standard drinks or 10.6gm alcohol. less. As a result, 26% of SBIRT patients no longer exceeded US low-risk alcohol consumption thresholds but just 17% of controls.

By six months and again at 12 months these promising effects had nearly or entirely dissipated and there were no statistically significant differences in alcohol consumption between intervention and control groups. At all three follow-up points, risky but probably not dependent CAGE screening test score under 2. drinkers did not respond Presumably correcting the earlier report on three-month outcomes which said risky but probably not dependent drinkers had responded better. significantly better to the intervention than possibly dependent CAGE screening test score 2 or more. drinkers.


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