1
|
Abiri P, Jeong ISD, Verdell A, Shah S, Entabi R, Nguyen H. Improvement in inpatient discharge planning for patients with alcohol use disorder with the implementation of a team-based multidisciplinary workflow. PLoS One 2024; 19:e0306066. [PMID: 38917202 PMCID: PMC11198838 DOI: 10.1371/journal.pone.0306066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is a major economic and healthcare burden in the United States. While there is evidence-based medication-assisted treatment (MAT) for AUD, few physicians implement these therapies on a regular basis. OBJECTIVE To determine the impact of a pharmacy-guided AUD discharge planning workflow on the rate of MAT prescriptions and inpatient readmissions. METHODS This was a single-centered pre-and-post intervention study over a 6-month period, with a 90-day pre-intervention period and a 90-day post-intervention period. The study included all patients over the age of 18 years admitted to a medicine or surgery floor bed who presented with alcohol withdrawal at any point during their hospital course. The intervention involved a pharmacy workflow, in which a list of patients admitted with alcohol withdrawal was automatically generated and referred to pharmacists, who then provided recommendations to the primary physician regarding prescriptions for naltrexone, acamprosate, and/or gabapentin. The patients were then contacted within 30 days after discharge for post-hospitalization follow-up. Our outcome measures were change in prescription rate of MATs, change in total and alcohol-related 90-day readmission rates, and change in total and alcohol-related 90-day emergency department (ED) visit rates. RESULTS The pre-intervention period consisted of 49 patients and the post-intervention period consisted of 41 patients. Our workflow demonstrated a 195% increase in the prescription rate of MATs at discharge (p < 0.001), 61% reduction in 90-day total readmission rate (p < 0.05), 40% reduction in 90-day total ED visit rate (p = 0.09), 92% reduction in 90-day alcohol-related readmission rate (p < 0.05), and 88% reduction in 90-day alcohol-related ED visit rate (p < 0.05). CONCLUSIONS Our intervention demonstrated that a pharmacy-based AUD discharge planning workflow has the potential to reduce inpatient readmissions and ED visits for patients with AUD, thus demonstrating improved patient outcomes with the potential to reduce healthcare costs.
Collapse
Affiliation(s)
- Parinaz Abiri
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, United States of America
| | - Il Seok Daniel Jeong
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, United States of America
| | - Amber Verdell
- Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA, United States of America
| | - Shivani Shah
- Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA, United States of America
| | - Rana Entabi
- Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA, United States of America
| | - Hoanglong Nguyen
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, United States of America
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| |
Collapse
|
2
|
Kools N, Dekker GG, Kaijen BAP, Meijboom BR, Bovens RHLM, Rozema AD. Interdisciplinary collaboration in the treatment of alcohol use disorders in a general hospital department: a mixed-method study. Subst Abuse Treat Prev Policy 2022; 17:59. [PMID: 35962380 PMCID: PMC9372961 DOI: 10.1186/s13011-022-00486-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/17/2022] Open
Abstract
Background Interdisciplinary collaborations (i.e., where various disciplines work coordinated and interdependently toward shared goals) are stated to yield higher team effectiveness than multidisciplinary approaches (i.e., where various disciplines work in parallel within their professional boundaries) in somatic health care settings. Nevertheless, research is lacking on interdisciplinary approaches for alcohol use disorder (AUD) treatment of hospitalized patients as these types of approaches are still uncommon. This study aims to evaluate an innovative interdisciplinary AUD treatment initiative at a general hospital department by 1) identifying which and to what extent network partners are involved and 2) to explore how network partners experienced the interdisciplinary collaboration. Methods A mixed-method study was conducted, using 1) measures of contact frequency and closeness in a social network analysis and 2) semi-structured interviews, which were analyzed thematically. Respondents were network partners of an interdisciplinary collaboration in a general hospital department, initially recruited by the collaborations’ project leader. Results The social network analysis identified 16 network partners, including a ‘core’ network with five central network partners from both inside and outside the hospital. The project leader played an important central role in the network and the resident gastroenterologist seemed to have a vulnerable connection within the network. Closeness between network partners was experienced regardless of frequency of contact, although this was especially true for the ‘core’ group that (almost) always consisted of the same network partners that were present at biweekly meetings. Interview data showed that presence of the ‘core’ network partners was reported crucial for an efficient collaboration. Respondents desired knowledge about the collaborations’ effectiveness, and one structured protocol with working procedures, division of responsibilities and agreements on information sharing and feedback. Conclusions The design of this interdisciplinary collaboration has potential in improving the treatment of hospital patients with AUD and was evaluated positively by the involved network partners. Interdisciplinary collaborations may offer a critical solution to increase treatment rates of patients with AUD and should be adopted in hospitals on a larger scale. Research towards the effectiveness of interdisciplinary collaborations in the treatment of hospitalized patients with AUD is needed.
Collapse
|
3
|
Chen CY, Lin CC, Kao JT, Yeh WL, Lin CY, Tsai YF. Predicting Hazardous Alcohol Drinking Behaviors in Family Members of Hazardous Alcohol-Drinker Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095497. [PMID: 35564892 PMCID: PMC9105135 DOI: 10.3390/ijerph19095497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022]
Abstract
Family members of hazardous or harmful alcohol drinkers suffer many consequences of their relative’s alcohol-drinking behaviors and risk developing their own hazardous alcohol drinking behaviors. Studies of alcohol-related healthcare problems have mainly focused on patients, with few studies on their family members. This cross-sectional study explored factors predicting hazardous alcohol drinking behaviors in family members of hazardous alcohol-drinker patients. Participants were recruited from four randomly chosen hospitals in Taiwan. Data were collected using self-report questionnaires on family members’ alcohol use, perceived stress, coping mechanisms, social support, health, quality of life, protective factors against hazardous alcohol drinking, facilitative factors for hazardous alcohol drinking, and demographics. The 318 family members who participated in this study were divided by their Chinese-version Alcohol Use Disorders Identification Test scores into two groups: hazardous alcohol drinkers (score ≥ 8) and non-hazardous alcohol drinkers (score < 8). Significant factors predicting hazardous alcohol drinking behaviors were found by logistic regression to be the frequency of using general coping mechanisms (OR = 1.29, p < 0.01), the frequency of using strategies to cope with patients’ drinking-related behaviors (OR = 0.89, p < 0.01), factors protecting against hazardous alcohol drinking (OR = 0.76, p < 0.01) and factors facilitating hazardous alcohol drinking (OR = 1.52, p < 0.01). Interventions should be designed for family members of hazardous alcohol drinkers to address these four significant predictors.
Collapse
Affiliation(s)
- Ching-Yen Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung City 204, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (C.-C.L.); (W.-L.Y.)
| | - Chen-Chun Lin
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (C.-C.L.); (W.-L.Y.)
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
| | - Jung-Ta Kao
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan;
- Division of Hepato-Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung City 404, Taiwan
| | - Wen-Ling Yeh
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (C.-C.L.); (W.-L.Y.)
- Department of Orthopedics, Lotung Poh-Ai Hospital, Luodong Township, Yilan County 265, Taiwan
| | - Chiao-Yun Lin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan;
| | - Yun-Fang Tsai
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung City 204, Taiwan;
- School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Taoyuan City 333, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 333, Taiwan
- Correspondence: ; Tel.: +886-3-2118800 (ext. 3204); Fax: +886-3-2118868
| |
Collapse
|
4
|
Kools N, van de Goor I, Bovens RHLM, van de Mheen D, Rozema AD. Impeding and facilitating factors for the implementation of alcohol interventions in hospitals: a qualitative and exploratory study among Dutch healthcare professionals. BMC Health Serv Res 2022; 22:6. [PMID: 34974830 PMCID: PMC8722137 DOI: 10.1186/s12913-021-07412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-moderated alcohol use is more prevalent among hospitalized patients compared to the general population. However, many hospitals fail to find and intervene with people with alcohol problems. We aimed to conduct an exploration of impeding and facilitating factors experienced by healthcare professionals in implementation of alcohol interventions in Dutch general hospitals. In addition, we explored the alcohol interventions used in the selected hospitals and involved stakeholders. Methods Through a qualitative study, semi-structured telephone interviews were conducted with twenty healthcare professionals working in or in collaboration with six different general hospitals. Results Healthcare professionals indicated impeding and facilitating factors in the areas of motivation, knowledge and skills, patient characteristics, protocol, internal and external collaboration/support, resources, role suitability and societal support. Five different categories of approaches to identify and intervene with non-moderated alcohol use and 18 involved stakeholders from both inside and outside the hospital were found. Conclusions Implementation of alcohol interventions for patients in Dutch general hospitals still seems to be in its infancy. Respondents emphasized the importance of one clear protocol on how to tackle alcohol problems within their hospital, repeated training on alcohol-related knowledge and skills, (clinical) “champions” that support healthcare professionals and developing and maintaining collaborations with stakeholders within and outside the hospital.
Collapse
Affiliation(s)
- Nathalie Kools
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Ien van de Goor
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| | - Rob H L M Bovens
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| | - Andrea D Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| |
Collapse
|
5
|
Steel TL, Afshar M, Edwards S, Jolley SE, Timko C, Clark BJ, Douglas IS, Dzierba AL, Gershengorn HB, Gilpin NW, Godwin DW, Hough CL, Maldonado JR, Mehta AB, Nelson LS, Patel MB, Rastegar DA, Stollings JL, Tabakoff B, Tate JA, Wong A, Burnham EL. Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e61-e87. [PMID: 34609257 PMCID: PMC8528516 DOI: 10.1164/rccm.202108-1845st] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. Goals: This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T0-T4 continuum to advance the care of hospitalized patients who experience SAWS. Methods: Clinicians and researchers with unique and complementary expertise in basic, clinical, and implementation research related to unhealthy alcohol consumption and alcohol withdrawal were invited to participate in a workshop at the American Thoracic Society 2019 International Conference. The committee was subdivided into four groups on the basis of interest and expertise: T0-T1 (basic science research with translation to humans), T2 (research translating to patients), T3 (research translating to clinical practice), and T4 (research translating to communities). A medical librarian conducted a pragmatic literature search to facilitate this work, and committee members reviewed and supplemented the resulting evidence, identifying key knowledge gaps. Results: The committee identified several investigative opportunities to advance the care of patients with SAWS in each domain of the translational science spectrum. Major themes included 1) the need to investigate non-γ-aminobutyric acid pathways for alcohol withdrawal syndrome treatment; 2) harnessing retrospective and electronic health record data to identify risk factors and create objective severity scoring systems, particularly for acutely ill patients with SAWS; 3) the need for more robust comparative-effectiveness data to identify optimal SAWS treatment strategies; and 4) recommendations to accelerate implementation of effective treatments into practice. Conclusions: The dearth of evidence supporting management decisions for hospitalized patients with SAWS, many of whom require critical care, represents both a call to action and an opportunity for the American Thoracic Society and larger scientific communities to improve care for a vulnerable patient population. This report highlights basic, clinical, and implementation research that diverse experts agree will have the greatest impact on improving care for hospitalized patients with SAWS.
Collapse
|
6
|
Smyth D, Wilson C, Searby A. Undergraduate nursing student knowledge and attitudes of healthcare consumers with problematic alcohol and other drug use: A scoping review. Int J Ment Health Nurs 2021; 30 Suppl 1:1293-1309. [PMID: 34363429 DOI: 10.1111/inm.12923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/20/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
Problematic alcohol and other drug use has a significant societal, personal, and financial burden. Nurses are key in responding to problematic alcohol and other drug use; however, research indicates many nurses hold negative attitudes towards people with substance and alcohol use disorders. Further, little content exists in most undergraduate degrees to address stigma held by new nurses. The objective of this scoping review, structured using Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8 (1), 19-32, 2005) framework, is to examine studies that either explore or attempt to improve the knowledge and attitudes of undergraduate nurses caring for people who use alcohol and other drugs. Our initial search located 610 articles, and after screening, 14 articles were appraised using the Mixed Methods Appraisal Tool (MMAT) and included in this review. Most of the papers appraised were small, localized studies using evaluation methods considered low quality, but showed promising results in addressing stigma and confidence in providing care to people who use alcohol and other drugs. This review indicates that a consistent direction for improving knowledge and attitudes among undergraduate nursing students working with people who use alcohol and other drugs is urgently needed. Further studies of interventions, tested with more rigorous evaluation methodologies, are required to extend existing work in this area.
Collapse
Affiliation(s)
- Darren Smyth
- Alcohol and Other Drugs Service, Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Cate Wilson
- Alcohol and Other Drugs Service, Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
7
|
Brief alcohol interventions in U.S. medical settings: A systematic review of the implementation literature. J Subst Abuse Treat 2021; 131:108456. [PMID: 34098287 DOI: 10.1016/j.jsat.2021.108456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Abstract
This systematic review provides a synthesis of the literature on brief alcohol intervention (BAI) implementation in medical settings. We utilized the Proctor et al. (2011) taxonomy of eight implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability) to organize and describe the qualitative and quantitative literature regarding BAI implementation. An electronic search of the PubMed database identified 25 articles that met inclusion criteria. The study team independently assessed all articles for methodological quality, with the majority of studies rated as weak to moderate. Descriptive and narrative review of the included articles identified penetration and acceptability as the two most commonly reported implementation outcomes. Studies rarely reported other outcomes (e.g., fidelity, cost, sustainability, adoption). On average, studies utilized approximately six implementation strategies to facilitate implementation, with education (96%), quality management (64%), and planning (56%) strategies the most frequently reported. Promising evidence exists that patients and providers are accepting of BAI implementation efforts and implementation efforts are helpful in expanding the reach of BAIs. A theory-informed approach to selecting implementation strategies may enhance implementation success in future work. When reporting on implementation, all studies should provide detailed BAI descriptions and strategies to enhance replication efforts. We suggest study designs that balance practical outcomes with methodological rigor to maximize the quality of future studies and better inform implementation efforts.
Collapse
|
8
|
Oxholm C, Christensen AMS, Christiansen R, Nielsen AS. Can We Talk about Alcohol for a Minute? Thoughts and Opinions Expressed by Health Professionals and Patients at a Somatic Hospital. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2020.1803168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina Oxholm
- Department for the Study of Culture, Faculty of Humanities, University of Southern Denmark, Odense, Denmark
| | | | - Regina Christiansen
- Department for the Study of Culture, Faculty of Humanities, University of Southern Denmark, Odense, Denmark
- Research Unit of Clinical Alcohol Research, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Research Unit of Clinical Alcohol Research, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- University Function, Psychiatric Hospital, Region of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Phillips T, Porter A, Sinclair J. Clinical Competencies for the Care of Hospitalized Patients with Alcohol Use Disorders. Alcohol Alcohol 2020; 55:395-400. [PMID: 32318727 PMCID: PMC7307320 DOI: 10.1093/alcalc/agaa024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/15/2020] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The UK government aims to develop alcohol care teams (ACTs) that provide care for alcohol dependence in general hospital settings. Service descriptors have been identified to support the development of ACTs. The aim of this study was to use Delphi panel principles to identify the clinical competencies required to provide these elements of service. METHODS We formed an expert consensus panel of 24 senior clinical alcohol practitioners, leaders and experts by experience drawn from all regions of England. The study was divided into three distinct phases: (a) a review and synthesis of current literature in this area, (b) a face-to-face meeting of the expert panel and (c) subsequent iterations to refine the competencies until consensus was reached. RESULTS Our initial search strategy resulted in 555 competency statements being extracted from a range of national clinical professional and occupational standards and other sources. The research team refined these statements to 98 competencies in advance of the expert meeting. The panel identified 14 additional statements and reduced the number of competencies to 78. Subsequent iterations finalized 72 competencies across the 8 service descriptors. CONCLUSIONS Drawing on the existing published resources and clinical experience, the expert panel has provided consensus on the core clinical competencies required for alcohol care teams in caring for hospitalized patients with alcohol use disorders. Whilst it is acknowledged that the range of current provision is variable, these competencies provide a template for clinical practice and the development of multidisciplinary ACTs.
Collapse
Affiliation(s)
- Thomas Phillips
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Amy Porter
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
10
|
Dengiz H, Daglioglu N, Goren IE. Assessment of recent alcohol consumption by detecting ethyl glucuronide and ethyl sulphate level among traffic accident patients. TRAFFIC INJURY PREVENTION 2020; 21:371-374. [PMID: 32496812 DOI: 10.1080/15389588.2020.1767777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
Objective: This study aims to explain whether EtG and EtS, which are two non-oxidative ethanol metabolites secreted by the liver and used as markers of alcohol intake related to an incident, were also present in whole blood samples of patients with traffic accident injuries.Methods: EtG and EtS concentrations in all of the whole blood samples were sent to the Forensic Medicine Department of Cukurova University for testing Blood Alcohol Concentrations (BAC) via validated liquid chromatography-tandem mass spectrometer method.Results: The scope of the study covers 200 patients that were admitted to medical services within 12 h following the incident. Of all patients 16.5% were found to be BAC positive, while 35.5 and 23.5 were positive for EtG and EtS, respectively. All samples with a positive BAC result were also positive for EtG and EtS.Conclusion: Detection of EtG and EtS, minor metabolites along with ethanol in the blood can serve as an objective tool to provide further analysis regarding alcohol-related traffic accidents at emergency services.
Collapse
Affiliation(s)
- Huseyin Dengiz
- Department of Forensic Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nebile Daglioglu
- Department of Forensic Medicine, Faculty of Medicine, University of Cukurova, Adana, Turkey
| | - Ismail Ethem Goren
- Department of Forensic Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| |
Collapse
|
11
|
Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study. Drug Alcohol Depend 2019; 204:107588. [PMID: 31590131 DOI: 10.1016/j.drugalcdep.2019.107588] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/03/2019] [Accepted: 08/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). METHODS A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. RESULTS Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. CONCLUSIONS The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.
Collapse
|
12
|
Roberts E, Morse R, Epstein S, Hotopf M, Leon D, Drummond C. The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta-analysis and meta-regression. Addiction 2019; 114:1726-1737. [PMID: 31269539 PMCID: PMC6771834 DOI: 10.1111/add.14642] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/24/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The prevalence of alcohol-related conditions is often reported as higher in hospital in-patients compared with the general population. However, formal prevalence estimates are commonly derived from small studies which report highly varied results. This systematic review and meta-analysis, within the UK hospital system, aimed to estimate the pooled prevalence of the 26 ICD-10 conditions that are wholly attributable to alcohol in in-patient settings. METHODS We searched Medline, Embase, PsychINFO and CENTRAL from database inception until 1 May 2018. We included studies of any design that reported the prevalence of one of 26 wholly attributable alcohol conditions defined by the ICD-10. Studies were required to be conducted in one or more of the constituent nations of the United Kingdom and in an in-patient setting (general wards, intensive care units, accident and emergency departments or mental health in-patient units). Estimates were pooled using random-effects meta-analysis, and meta-regression tested study and patient factors contributing to variation. Quality was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. RESULTS A total of 124 studies were included, reporting on a total of 1 657 614 patients. The majority of studies reported on harmful use of alcohol and alcohol dependence, for which the pooled prevalence was 19.76% [95% confidence interval (CI) = 15.61-24.26%] and 10.25% (95% CI = 7.06-13.96%), respectively. Mean patient age and type of in-patient setting were identified as the main sources of variation in prevalence estimates, but not date of data collection. Both estimates were deemed very low quality according to GRADE. CONCLUSIONS An estimated one in five patients in the UK hospital system use alcohol harmfully, and one in 10 are alcohol-dependent.
Collapse
Affiliation(s)
- Emmert Roberts
- National Addiction Centre and the Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation TrustLondonUK
| | - Rachel Morse
- Brighton and Sussex Medical SchoolUniversity of Brighton and the University of SussexBrightonUK
| | - Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and the Maudsley NHS Foundation Trust; Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Matthew Hotopf
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation TrustLondonUK
| | - David Leon
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Colin Drummond
- National Addiction Centre and the Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation TrustLondonUK
| |
Collapse
|
13
|
McNeely J, Haley SJ, Smith AJ, Leonard NR, Cleland CM, Ferdschneider M, Calderoni M, Sleiter L, Ciotoli C, Adam A. Computer self-administered screening for substance use in university student health centers. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:541-550. [PMID: 30240331 PMCID: PMC6428636 DOI: 10.1080/07448481.2018.1498852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/11/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: To characterize the prevalence of tobacco, alcohol, and drug use and the acceptability of screening in university health centers. Participants: Five hundred and two consecutively recruited students presenting for primary care visits in February and August, 2015, in two health centers. Methods: Participants completed anonymous substance use questionnaires in the waiting area, and had the option of sharing results with their medical provider. We examined screening rates, prevalence, and predictors of sharing results. Results: Past-year use was 31.5% for tobacco, 67.1% for alcohol (>4 drinks/day), 38.6% for illicit drugs, and 9.2% for prescription drugs (nonmedical use). A minority (43.8%) shared screening results. Sharing was lowest among those with moderate-high risk use of tobacco (OR =0.37, 95% CI 0.20-0.69), alcohol (OR =0.48, 95% CI 0.25-0.90), or illicit drugs (OR =0.38, 95% CI 0.20-0.73). Conclusions: Screening can be integrated into university health services, but students with active substance use may be uncomfortable discussing it with medical providers.
Collapse
Affiliation(s)
- Jennifer McNeely
- Department of Population Health, NYU School of Medicine, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine, NYU School of Medicine, New York, New York, USA
| | - Sean J. Haley
- Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Allison J. Smith
- Student Health Center, New York University, New York, New York, USA
| | - Noelle R. Leonard
- Center on Drug Use and HIV Research and NYU College of Nursing, New York University, New York, New York, USA
| | - Charles M. Cleland
- Center on Drug Use and HIV Research and NYU College of Nursing, New York University, New York, New York, USA
| | | | | | - Luke Sleiter
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Carlo Ciotoli
- Student Health Center, New York University, New York, New York, USA
| | - Angéline Adam
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| |
Collapse
|
14
|
Wakeman SE, Herman G, Wilens TE, Regan S. The prevalence of unhealthy alcohol and drug use among inpatients in a general hospital. Subst Abus 2019; 41:331-339. [PMID: 31368860 DOI: 10.1080/08897077.2019.1635961] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Unhealthy substance use is a growing public health issue. Intersections with the health care system offer an opportunity for intervention; however, recent estimates of prevalence for unhealthy substance use among all types of hospital inpatients are unknown. Methods: Universal screening for unhealthy alcohol or drug use was implemented across a 999-bed general hospital between January 1 and December 31, 2015. Nurses completed alcohol screening using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) with a cutoff of ≥5 for moderate risk and ≥8 for high risk and drug screening using the single-item screening question with ≥1 episode of use considered positive. Results: Out of 35,288 unique inpatients, screens were completed on 21,519. There were 3,451 positive screens (16% of all completed screens), including 1,291 (6%) moderate risk and 1,111 (5%) high risk screens for alcohol and 1,657 (8%) positive screens for drug use. Among screens that were positive for moderate- or high-risk alcohol use, 221 (17%) and 297 (27%), respectively, were concurrently positive for drug use. The majority (61%) of patients with unhealthy alcohol use was on the medical services. Men, those who were white or Hispanic, middle-aged, single, unemployed, or screened positive for drug use were more likely to screen positive for high-risk alcohol use. Those who were younger, single, worked less than full time, or screened high risk for alcohol were more likely to screen positive for drug use. Discordance between diagnosis coding and screening results was noted: 29% of high-risk alcohol use screens had no alcohol diagnosis coding associated with that admission, and 51% of patients with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis code of alcohol dependence had AUDIT-C scores of <8. Conclusions: Across a general hospital, 16% of patients screened positive for unhealthy substance use, with the highest volume on medical floors. Nursing-led screening may offer an opportunity to identify and engage patients with unhealthy substance use during hospitalization.
Collapse
Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace Herman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Regan
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Making a bridge between general hospital and specialised community-based treatment for alcohol use disorder-A pragmatic randomised controlled trial. Drug Alcohol Depend 2019; 196:51-56. [PMID: 30665152 DOI: 10.1016/j.drugalcdep.2018.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
AIM To investigate if more patients in the intervention group attended specialized alcohol treatment compared with a treatment-as-usual group (TAU). METHODS Pragmatic randomized controlled trial where consecutive patients, admitted to somatic hospitals, filled out a lifestyle questionnaire with the Alcohol Use Disorder Identification Test (AUDIT) embedded. Patients scoring 8+ on AUDIT were included in the study. Included patients were randomized to either a Danish screening brief intervention and referral to treatment (SBIRT) called the Relay model or TAU depending on date of admission. The Relay group was offered a brief alcohol intervention by an outreach alcohol therapist. Patients scoring 16 points and above on the AUDIT test also received referral to alcohol treatment. Outcome was attendance at specialized outpatient alcohol treatment centres after discharge from hospital. Information on patients was gathered from municipal databases at 18 months follow-up. RESULTS A total of 3534 patients completed the questionnaire, and 609 patients (17%) scored AUDIT 8+. 48 patients were lost to follow-up, and the final sample had 561 patients. Only 33 patients (6%) attended outpatient treatment at 18-months follow-up, but significantly more patients in the Relay group sought alcohol treatment than in the TAU group (OR = 2.5 [1.2;5.2] (p = 0.017)). Number needed to treat (NNT) was 20 [95% CI 11.2;112.3]. CONCLUSION The Relay intervention was associated with more patients attending specialized treatment, but further research is needed to establish if general hospitals are an excellent platform for performing SBIRT.
Collapse
|
16
|
Fernandez AC, Waller R, Walton MA, Bonar EE, Ignacio RV, Chermack ST, Cunningham RM, Booth BM, Ilgen MA, Barry KL, Blow FC. Alcohol use severity and age moderate the effects of brief interventions in an emergency department randomized controlled trial. Drug Alcohol Depend 2019; 194:386-394. [PMID: 30485827 PMCID: PMC6342480 DOI: 10.1016/j.drugalcdep.2018.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The primary aim of this study was to examine the efficacy of two motivational interviewing-based alcohol brief interventions (BIs) among adults presenting to an emergency department (ED). The secondary aim was to evaluate moderators of intervention effects. METHODS Participants were 750 ED patients reporting recent alcohol misuse. Participants were randomly assigned to: 1) computer-delivered BI (Computer BI), 2) therapist-delivered BI with computer guidance (Therapist BI-CG), or 3) control. The BIs focused on reduction of alcohol use and risk behaviors. The outcome measure was trajectories of alcohol consumption (measured by the AUDIT-C) across baseline, 3-, 6- and 12-month follow-up assessments, analyzed using latent growth curve modeling. Moderation of intervention effect by gender, age, and baseline alcohol use disorder severity was examined. RESULTS Across the full sample (40% males, mean age = 35.8, SD = 12.3), there was an overall reduction in alcohol consumption across 12 months. The main effects of the Therapist and Computer BI were not significant relative to control. Moderation analysis revealed that the impact of Therapist BI-CG, relative to control, was greater on reductions in alcohol consumption in participants with moderate to severe symptoms of alcohol use disorder compared to those with mild symptoms. The effect of the Computer BI on alcohol use, relative to control, was greater among younger participants compared to older participants. CONCLUSIONS While no overall effect was shown, ED-based Therapist BI-CG with computer guidance may be effective among patients with moderate-severe drinking patterns, whereas Computer BIs may be more effective for younger participants.
Collapse
Affiliation(s)
- Anne C Fernandez
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA.
| | - Rebecca Waller
- University of Pennsylvania, Department of Psychology, Philadelphia, PA 19104, USA
| | - Maureen A Walton
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA
| | - Rosalinda V Ignacio
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, 48105, USA
| | - Rebecca M Cunningham
- Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA; Michigan Medicine, Department of Emergency Medicine, Ann Arbor, MI, 48109, United States; Hurley Hospital, Flint, MI, 48503, USA; University of Michigan, School of Public Health, Ann Arbor, MI, 48109, USA
| | - Brenda M Booth
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, 72205, USA
| | - Mark A Ilgen
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, 48105, USA
| | - Kristen L Barry
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
| |
Collapse
|
17
|
Schwarz AS, Nielsen B, Nielsen AS. Lifestyle factors in somatic patients with and without potential alcohol problems. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
18
|
Hsu KY, Tsai YF, Huang CC, Yeh WL, Chang KP, Lin CC, Chen CY, Lee HL. Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System. JMIR Mhealth Uhealth 2018; 6:e142. [PMID: 29891467 PMCID: PMC6018239 DOI: 10.2196/mhealth.9783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022] Open
Abstract
Background Smoking tobacco, drinking alcohol, and chewing betel quid are health-risk behaviors for several diseases, such as cancer, cardiovascular disease, and diabetes, with severe impacts on health. However, health care providers often have limited time to assess clients’ behaviors regarding smoking tobacco, drinking alcohol, and chewing betel quid and intervene, if needed. Objective The objective of this study was to develop a Web-based survey system; determine the rates of tobacco-smoking, alcohol-drinking, and betel-quid-chewing behaviors; and estimate the efficiency of the system (time to complete the survey). Methods Patients and their family members or friends were recruited from gastrointestinal medical–surgical, otolaryngology, orthopedics, and rehabilitation clinics or wards at a medical center in northern Taiwan. Data for this descriptive, cross-sectional study were extracted from a large series of research studies. A Web-based survey system was developed using a Linux, Apache, MySQL, PHP stack solution. The Web survey was set up to include four questionnaires: the Chinese-version Fagerstrom Tolerance Questionnaire, the Chinese-version Alcohol Use Disorders Identification Test, the Betel Nut Dependency Scale, and a sociodemographic form with several chronic diseases. After the participants completed the survey, the system automatically calculated their score, categorized their risk level for each behavior, and immediately presented and explained their results. The system also recorded the time each participant took to complete the survey. Results Of 782 patient participants, 29.6% were addicted to nicotine, 13.3% were hazardous, harmful, or dependent alcohol drinkers, and 1.5% were dependent on chewing betel quid. Of 425 family or friend participants, 19.8% were addicted to nicotine, 5.6% were hazardous, harmful, or dependent alcohol drinkers, and 0.9% were dependent on chewing betel quid. Regarding the mean time to complete the survey, patients took 7.9 minutes (SD 3.0; range 3-20) and family members or friends took 7.7 minutes (SD 2.8; range 3-18). Most of the participants completed the survey within 5-10 minutes. Conclusions The Web-based survey was easy to self-administer. Health care providers can use this Web-based survey system to save time in assessing these risk behaviors in clinical settings. All smokers had mild-to-severe nicotine addiction, and 5.6%-12.3% of patients and their family members or friends were at risk of alcohol dependence. Considering that these three behaviors, particularly in combination, dramatically increase the risk of esophageal cancer, appropriate and convenient interventions are necessary for preserving public health in Taiwan.
Collapse
Affiliation(s)
- Kuo-Yao Hsu
- Division of Orthopedic Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chu-Ching Huang
- Division of Natural Science, Center for General Education, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Ling Yeh
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Kai-Ping Chang
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Division of Head & Neck Surgery, Department of Otolaryngology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Chen-Chun Lin
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Ching-Yen Chen
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hsiu-Lan Lee
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| |
Collapse
|
19
|
Busch AC, Denduluri M, Glass J, Hetzel S, Gugnani SP, Gassman M, Krahn D, Deyo B, Brown R. Predischarge Injectable Versus Oral Naltrexone to Improve Postdischarge Treatment Engagement Among Hospitalized Veterans with Alcohol Use Disorder: A Randomized Pilot Proof-of-Concept Study. Alcohol Clin Exp Res 2017; 41:1352-1360. [PMID: 28605827 DOI: 10.1111/acer.13410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/21/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injectable naltrexone for alcohol use disorders (AUDs) has been efficacious in several studies. It has not been (i) compared head-to-head with oral naltrexone or (ii) examined in the hospital setting as an intervention that might facilitate treatment attendance after hospital discharge. METHODS Fifty-four hospitalized veterans identified as having DSM-IV-TR alcohol dependence were randomized to receive (i) a 50 mg oral naltrexone plus a 30-day prescription or (ii) a 380 mg intramuscular naltrexone injection prior to discharge. Of 113 veteran inpatients deemed eligible based on screening criteria, 54 met final eligibility criteria and were enrolled and randomized. Baseline data included demographics, alcohol consumption, and comorbidity. Measures of treatment initiation and engagement and alcohol consumption were reassessed at 14- and 45-day follow-ups. RESULTS Thirty-five participants (64.8%) completed the entire study protocol (received a study medication and completed 14- and 45-day follow-ups). Among those who received a study medication (n = 45), 77.8% completed all follow-up interviews. This pilot study was not designed to have sufficient statistical power for hypothesis testing, and thus, as expected, there were no significant differences between groups in medication adherence (self-report of >80% of daily doses taken in oral group; receipt of second injection in the injection group), treatment engagement (at least treatment 3 visits in the 30 days postdischarge, and 2 or more visits per month in each of the 3 months following discharge) or alcohol consumption at 14 or at 45 days (p > 0.05). The median number of drinks among the entire cohort in the 2 weeks prior to hospitalization (128 drinks) was significantly higher than at day 14 (0 drinks, p < 0.001) or day 45 (0 drinks, p < 0.001). Rates of medication adherence were 62% in the oral group and 61% in the injection group. CONCLUSIONS Results indicate feasibility for larger, more definitive study. Both groups had significant reductions in alcohol consumption over time and high-treatment engagement rates. Both oral and injectable formulations are feasible to initiate prior to discharge for hospital inpatients identified as having an AUD.
Collapse
Affiliation(s)
- Angela Christina Busch
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | | | - Joseph Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, Seattle, Wisconsin
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Shalu P Gugnani
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | - Michele Gassman
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Dean Krahn
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Brienna Deyo
- Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
20
|
Lin CC, Tsai YF, Yeh WL, Kao JT, Chen CY. Perceptions of problem-drinker patients' family members about their own hazardous-drinking behaviours in Chinese general hospitals: a qualitative study. BMC Psychiatry 2017; 17:189. [PMID: 28521730 PMCID: PMC5437516 DOI: 10.1186/s12888-017-1348-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excessive alcohol use has been associated with health, social and legal problems. Alcohol-related problems have been studied primarily in problem-drinker patients, with few studies on their family members, particularly about their own hazardous or harmful alcohol-drinking behaviours. METHOD In this qualitative descriptive study, participants were recruited from three hospitals randomly selected from northern and central Taiwan (2:1). Hazardous-drinker patients and their family members were screened using the Chinese version Alcohol Use Disorders Identification Test (scores ≥8 indicate harmful or hazardous drinkers). Data were collected in individual, audiotaped, in-depth interviews using an interview guide. Verbatim interview transcripts were analysed using ATLAS.ti, version WIN 7.0. RESULTS The sample of 35 family members with hazardous or harmful drinking behaviours perceived that their own alcohol-drinking behaviours were related to six major patterns: family habits, leisure activities with friends, work pressures, personal taste, a way to forget one's problems and to express happiness. CONCLUSION We recommend that programmes targeting harmful or hazardous drinking among problem-drinker patients' family members should educate participants about the standard amounts of alcohol in alcoholic beverages, recommended amounts of alcohol consumption for males and females, the long-term effects of excessive alcohol consumption; address sources of risk factors at work; offer strategies to resist social pressures to drink; and build positive strategies for coping with stress.
Collapse
Affiliation(s)
- Chen-Chun Lin
- 0000 0004 1756 1461grid.454210.6Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. .,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan. .,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
| | - Wen-Ling Yeh
- 0000 0004 1756 1461grid.454210.6Department of Traumatology Orthopedics, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Jung-Ta Kao
- 0000 0001 0083 6092grid.254145.3School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ,0000 0004 0572 9415grid.411508.9Department of Internal Medicine, Division of Hepato-Gastroenterology, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Yen Chen
- 0000 0004 0639 2551grid.454209.eDepartment of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan ,grid.145695.aCollege of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| |
Collapse
|
21
|
O'connor K, Meyer V, Chard A, Nagel J, Jones RJ, Bokhart GH, Kunkle WA, Zimmerman SA, Reed DN. The Triple-Negative Test for Alcohol Dependence: A Reliability Study. Am Surg 2016. [DOI: 10.1177/000313481608200602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kevin O'connor
- Indiana University School of Medicine Indianapolis, Indiana
| | - Vickie Meyer
- Trauma Services Lutheran Hospital of Indiana Fort Wayne, Indiana
| | - Annette Chard
- Trauma Services Lutheran Hospital of Indiana Fort Wayne, Indiana
| | - Joel Nagel
- Trauma Services Lutheran Hospital of Indiana Fort Wayne, Indiana
| | - Ronald J. Jones
- Research Department Lutheran Hospital of Indiana Fort Wayne, Indiana
| | - Gordon H. Bokhart
- Research Department Lutheran Hospital of Indiana Fort Wayne, Indiana
| | | | | | - Donald N. Reed
- Indiana University School of Medicine Indianapolis, Indiana Trauma Services; and Lutheran Hospital of Indiana Fort Wayne, Indiana
| |
Collapse
|
22
|
Schmidt CS, Schulte B, Seo HN, Kuhn S, O'Donnell A, Kriston L, Verthein U, Reimer J. Meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings. Addiction 2016; 111:783-94. [PMID: 26637990 DOI: 10.1111/add.13263] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/17/2015] [Accepted: 11/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. METHODS We included peer-reviewed, randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002-September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3-, 6- and 12-month follow-up, resulting in nine separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. RESULTS We considered 33 publications (28 separate studies) including 14 456 patients. Six of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 [95% confidence interval (CI) = 0.08-0.31]. No significant moderators could be identified, and statistical heterogeneity (I(2) ) was below 40%. CONCLUSIONS In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear to be comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies.
Collapse
Affiliation(s)
- Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ha-Na Seo
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Kuhn
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
23
|
Schwarz AS, Bilberg R, Bjerregaard L, Nielsen B, Søgaard J, Nielsen AS. Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial. BMC Health Serv Res 2016; 16:132. [PMID: 27080865 PMCID: PMC4832463 DOI: 10.1186/s12913-016-1376-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background A large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model. Method/Design The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used. Discussion We expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures. Trial registration https://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)
Collapse
Affiliation(s)
- Anne-Sophie Schwarz
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Randi Bilberg
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lene Bjerregaard
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jes Søgaard
- The Danish Cancer Society and Aarhus University, Faculty of Health Science, Institute of Clinical Medicine, Department of Clinical Epidemiology, Copenhagen, Denmark
| | - Anette Søgaard Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
24
|
Rosón B, Corbella X, Perney P, Santos A, Stauber R, Lember M, Arutyunov A, Ruza I, Vaclavik J, García L, Pujol R, Stauber R, Vogel W, Vaclavik J, Gajdová J, Smrzova A, Liberdová A, Cibickova L, Plasek J, Svarcova T, Salupere R, Lember M, Rosón B, Guillem MN, Fernández-Sola J, Zapatero A, Monte R, Puerta RB, Gamallo R, Durán C, Perney P, Ouakli A, Oziol E, Bastide D, Tourneaire P, Allard G, Cros H, Piala JM, Quere I, Condouret S, Ruža I, Funka K, Zarina L, Barata J, Gonsalves O, Santos A, Oliveira N, Yakushin S, Petrovicheva L, Sleptsov A, Arutyunov A, Mitkhat G, Marusenko I. Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study. Alcohol Alcohol 2016; 51:457-64. [DOI: 10.1093/alcalc/agv142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/30/2015] [Indexed: 11/14/2022] Open
|
25
|
Mundt MP, Zakletskaia LI, Shoham DA, Tuan WJ, Carayon P. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs. Alcohol Clin Exp Res 2015; 39:2003-15. [PMID: 26350957 DOI: 10.1111/acer.12831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. METHODS Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. RESULTS Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. CONCLUSIONS Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members.
Collapse
Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Larissa I Zakletskaia
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David A Shoham
- Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Wen-Jan Tuan
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Pascale Carayon
- College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
26
|
Fernandez AC, Claborn KR, Borsari B. A systematic review of behavioural interventions to reduce preoperative alcohol use. Drug Alcohol Rev 2015; 34:508-520. [PMID: 26120973 DOI: 10.1111/dar.12285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/21/2015] [Indexed: 11/29/2022]
Abstract
ISSUES Preoperative alcohol use is associated with an increase in postoperative morbidity and mortality. Short-term abstinence prior to elective surgery has been shown to reduce postoperative risks. Therefore, behavioural intervention (BI) targeting risky drinking may have significant utility in preventing surgical complications. APPROACH The literature was systematically reviewed to identify the scope and outcomes of BIs aiming to reduce alcohol use in risky drinkers before they underwent surgery. Five databases were searched using PRISMA criteria. Of 1243 studies identified, four met pre-established inclusion criteria: (i) implementation of a BI prior to an elective surgery; (ii) the BI-targeted alcohol use among risky drinkers; and (iii) printed in English. KEY FINDINGS Two studies indicated significant reductions in alcohol use at follow ups, and one study demonstrated reductions in postoperative risks. These findings are encouraging, but in light of methodological limitations, the efficacy of preoperative BIs for risky drinking could not be determined. IMPLICATIONS Future efforts to screen and implement BIs addressing alcohol use in preoperative patients should carefully define risky drinking, allow ample time for recruitment prior to surgery, implement empirically supported interventions, examine the impact of relevant covariates, and consider the statistical power needed to detect change in postoperative complications. CONCLUSION Given the strong link between preoperative alcohol use and postoperative risks, additional research on preoperative BIs is critically needed. Existing research suggests several promising directions for research that may enhance future intervention efforts with this high-risk population. [Fernandez AC, Claborn KR, Borsari B. A systematic review of behavioural interventions to reduce preoperative alcohol use. Drug Alcohol Rev 2015;34:508-20].
Collapse
Affiliation(s)
- Anne C Fernandez
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA
| | - Kasey R Claborn
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA
| | - Brian Borsari
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA.,Mental Health and Behavioral Sciences Service, Providence Veteran's Affairs Medical Center, Providence, USA
| |
Collapse
|
27
|
Monte-Secades R, Rabuñal-Rey R, Guerrero-Sande H. Síndrome de abstinencia alcohólica en pacientes hospitalizados. Rev Clin Esp 2015; 215:107-16. [DOI: 10.1016/j.rce.2014.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/15/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
|
28
|
Inpatient alcohol withdrawal syndrome. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
29
|
Rehm J, Anderson P, Barry J, Dimitrov P, Elekes Z, Feijão F, Frick U, Gual A, Gmel G, Kraus L, Marmet S, Raninen J, Rehm MX, Scafato E, Shield KD, Trapencieris M, Gmel G. Prevalence of and potential influencing factors for alcohol dependence in Europe. Eur Addict Res 2015; 21:6-18. [PMID: 25342593 DOI: 10.1159/000365284] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
Abstract
Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.
Collapse
Affiliation(s)
- Jürgen Rehm
- Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health, Toronto, Ont., Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Rehm J, Dawson D, Frick U, Gmel G, Roerecke M, Shield KD, Grant B. Burden of disease associated with alcohol use disorders in the United States. Alcohol Clin Exp Res 2014; 38:1068-77. [PMID: 24428196 PMCID: PMC4147870 DOI: 10.1111/acer.12331] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 11/01/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Alcohol use disorders (AUD) have long been considered to be some of the most disabling mental disorders; however, empirical data on the burden of disease associated with AUD have been sparse. The objective of this article is to quantify the burden of disease (in disability-adjusted life years [DALYs] lost), deaths, years of life lost due to premature mortality (YLL), and years of life lost due to disability (YLD) associated with AUD for the United States in 2005. METHODS Statistical modeling was based on epidemiological indicators derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Formal consistency analyses were applied. Risk relations were taken from recent meta-analyses and the disability weights from the burden of disease study of the National Institutes of Health. Monte Carlo simulations were used to derive confidence intervals. All analyses were performed by sex and age. Sensitivity analyses were undertaken on key indicators. RESULTS In the United States in 2005, 65,000 deaths, 1,152,000 YLL, 2,443,000 YLD, and 3,595,000 DALYs were associated with AUD. For individuals 18 years of age and older, AUD were associated with 3% of all deaths (5% for men and 1% for women), and 5% of all YLL (7% for men and 2% for women). The majority of the burden of disease associated with AUD stemmed from YLD, which accounted for 68% of DALYs associated with AUD (66% for men and 74% for women). The youngest age group had the largest proportion of DALYs associated with AUD stemming from YLD. CONCLUSIONS Using data from a large representative survey (checked for consistency) and by combining these data with the best available evidence, we found that AUD were associated with a larger burden of disease than previously estimated. To reduce this disease burden, implementation of prevention interventions and expansion of treatment are necessary.
Collapse
Affiliation(s)
- Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Germany; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
31
|
Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol 2014; 43:906-19. [DOI: 10.1093/ije/dyu018] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
32
|
Mainerova B, Prasko J, Latalova K, Axmann K, Cerna M, Horacek R, Bradacova R. Alcohol withdrawal delirium - diagnosis, course and treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 159:44-52. [PMID: 24399242 DOI: 10.5507/bp.2013.089] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 11/21/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Delirium tremens represents the most severe complication of alcohol withdrawal syndrome and, in its complications, significantly increases the morbidity and mortality of patients. Alcohol withdrawal delirium is characterized by features of alcohol withdrawal itself (tremor, sweating, hypertension, tachycardia etc.) together with general delirious symptoms such as clouded consciousness, disorientation, disturbed circadian rhythms, thought processe and sensory disturbances, all of them fluctuating in time. The treatment combines a supportive and symptomatic approach. Benzodiazepines in supramaximal doses are usually used as drugs of choice but in some countries such as the Czech Republic or Germany, clomethiazole is frequently used as well. METHOD A computer search of the all the literature published between 1966 and December 2012 was accomplished on MEDLINE and Web of Science with the key words "delirium tremens", "alcohol withdrawal", "treatment" and "pharmacotherapy". There were no language or time limits applied. CONCLUSIONS When not early recognized and treated adequately, delirium tremens may result in death due to malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance or prolonged seizures and subsequent trauma. Owing to these possible fatalities and other severe unexpected complications, delirium tremens should be managed at an ICU or wards ensuring vital signs monitoring. In symptomatic treatment, high doses of benzodiazepines, especially lorazepam, diazepam and oxazepam are considered the gold standard drugs. Supportive therapy is also of great importance.
Collapse
Affiliation(s)
- Barbora Mainerova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | | | | | | | | | | | | |
Collapse
|
33
|
Makdissi R, Stewart SH. Care for hospitalized patients with unhealthy alcohol use: a narrative review. Addict Sci Clin Pract 2013; 8:11. [PMID: 23738519 PMCID: PMC3679958 DOI: 10.1186/1940-0640-8-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/24/2013] [Indexed: 12/31/2022] Open
Abstract
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.
Collapse
Affiliation(s)
- Regina Makdissi
- Division of General Internal Medicine, University at Buffalo State University of New York, Buffalo, NY, USA
| | | |
Collapse
|
34
|
Nantsupawat T, Ono C, Umyarova E, Mankongpaisarnrung C, Panikkath R, Arvandi A, Perez-Verdia A, Bunag T, Meyerrose G. Effects of Alcohol and Illicit Substance Consumption in Patients with Infective Endocarditis. ALCOHOLISM TREATMENT QUARTERLY 2013. [DOI: 10.1080/07347324.2013.749148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
35
|
Gender-specific predictors of risky alcohol use among general hospital inpatients. Gen Hosp Psychiatry 2013; 35:9-15. [PMID: 23141029 DOI: 10.1016/j.genhosppsych.2012.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/15/2012] [Accepted: 08/21/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate sociodemographic-, living situation- and substance-related variables as predictors of current risky alcohol use for both female and male general hospital inpatients. METHOD The sample of 6050 female and 8282 male general hospital inpatients was recruited in 2002-2004. Using the Alcohol Use Disorder Identification Test-Consumption, they were assigned to four drinking groups: abstinent, moderate use, slightly increased use and notably increased use. Gender-specific predictors of group affiliation were determined using multivariate multinomial logistic regressions. RESULTS In both genders, younger age, rural living environment, the occurrence of lifetime alcohol use disorders (AUDs) and current tobacco smoking were positively associated with risky alcohol use. Higher education was positively associated with slightly and notably increased use for women. Living alone, being divorced/ widowed and being unemployed (relative risk ratios=1.4-1.7) were positively associated with notably increased use for men. In both genders, older age, less education and the occurrence of lifetime AUDs were positively associated with abstinence. CONCLUSIONS Higher educated women are likely to report risky alcohol use. Marriage may have a protective effect on level of alcohol use for men only. In addition to the implementation of routine alcohol screening, the examined data may provide cost-effective information that could be used to tailor interventions.
Collapse
|
36
|
Tsai YF, Lin YP, Tsai MC, Weng CE, Chen CY. Hazardous alcohol-drinking problems among a Chinese hospital patient population. J Adv Nurs 2012; 69:1819-28. [PMID: 23157429 DOI: 10.1111/jan.12043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2012] [Indexed: 11/28/2022]
Abstract
AIM The aims of this study were to explore: (1) the prevalence and predictors for hazardous alcohol-drinking problems; and (2) previous assessments and interventions for alcohol-drinking problems in hospitalized Chinese patients. BACKGROUND Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings. DESIGN A cross-sectional design was used. METHOD Self-report data were collected in 2009 from 484 patients at five randomly selected general teaching hospitals. FINDINGS The prevalence of hazardous alcohol-drinking problems was 19·2%. Logistic regression analysis revealed that predictors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29·1% of participants had been assessed for drinking problems in the past year. Only 38·7% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION These findings suggest that alcohol problems in Taiwanese general teaching hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups in general teaching hospitals is important to prevent patients' drinking problems.
Collapse
Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | | | | | | | | |
Collapse
|
37
|
Tsai YF, Chen CY, Lin YP, Tsai MC, Weng CE. Hazardous drinking problems in family members of problem-drinker patients in Chinese general hospitals. Gen Hosp Psychiatry 2012; 34:633-8. [PMID: 22771107 DOI: 10.1016/j.genhosppsych.2012.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 06/05/2012] [Accepted: 06/05/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among family members of Chinese problem-drinker patients. METHOD Self-report data were collected from 517 family members of problem-drinker patients at five randomly selected general hospitals in Taiwan. RESULTS Family members' prevalence of hazardous alcohol-drinking problems was 13.3%. Logistic regression analysis revealed that risk factors for hazardous drinking were male gender, low education level, heart disease, smoking, and chewing betel quid. Only 11.8% of participants had been assessed for drinking problems in the past year. Only 5.2% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION Alcohol problems among family members of problem-drinker patients in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting this high-risk group is important to prevent drinking problems in family members of problem-drinker patients.
Collapse
Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
| | | | | | | | | |
Collapse
|
38
|
Mitchell AJ, Meader N, Bird V, Rizzo M. Clinical recognition and recording of alcohol disorders by clinicians in primary and secondary care: meta-analysis. Br J Psychiatry 2012; 201:93-100. [PMID: 22859576 DOI: 10.1192/bjp.bp.110.091199] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinicians have considerable difficulty identifying and helping those people with alcohol problems but no previous study has looked at this systematically. AIMS To determine clinicians' ability to routinely identify broadly defined alcohol problems. METHOD Data were extracted and rated by two authors, according to PRISMA standard and QUADAS criteria. Studies that examined the diagnostic accuracy of clinicians' opinion regarding the presence of alcohol problems as well as their written notation were evaluated. RESULTS A comprehensive search identified 48 studies that looked at the routine ability of clinicians to identify alcohol problems (12 in primary care, 31 in general hospitals and 5 in psychiatric settings). A total of 39 examined alcohol use disorder, 5 alcohol dependence and 4 intoxication. We separated studies into those using self-report and those using interview. The diagnostic sensitivity of primary care physicians (general practitioners) in the identification of alcohol use disorder was 41.7% (95% CI 23.0-61.7) but alcohol problems were recorded correctly in only 27.3% (95% CI 16.9-39.1) of primary care records. Hospital staff identified 52.4% (95% CI 35.9-68.7) of cases and made correct notations in 37.2% (95% CI 28.4-46.4) of case notes. Mental health professionals were able to correctly identify alcohol use disorder in 54.7% (95% CI 16.8-89.6) of cases. There were limited data regarding alcohol dependency and intoxication. Hospital staff were able to detect 41.7% (95% CI 16.5-69.5) of people with alcohol dependency and 89.8% (95% CI 70.4-99.4) of those acutely intoxicated. Specificity data were sparse. CONCLUSIONS Clinicians may consider simple screening methods such as self-report tools rather than relying on unassisted clinical judgement but the added value of screening over and above clinical diagnosis remains unclear.
Collapse
Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicester Partnership Trust, Leicester, UK.
| | | | | | | |
Collapse
|
39
|
O'Brien A, Leonard L, Deering D. Could an advance practice nurse improve detection of alcohol misuse in the emergency department? Int J Ment Health Nurs 2012; 21:340-8. [PMID: 22540263 DOI: 10.1111/j.1447-0349.2011.00797.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alcohol misuse is a prevalent problem in New Zealand society, and one that exacts a considerable cost in terms of health, social cohesion, and economic productivity. Despite the burden of alcohol misuse, screening, brief assessment, and interventions for alcohol problems are frequently poorly performed within general health services. In this paper we explore the response to alcohol problems in a New Zealand emergency department and discuss difficulties encountered in improving rates of detection by emergency department personnel. We report the results of a clinical audit of alcohol screening and brief assessment and a staff education programme designed to improve practice in this area, but which met with limited success. The potential role for an advanced practice nurse providing a clinical consultation and liaison service to the emergency department staff is explored. We argue that such a role has potential to reduce the health and social costs of alcohol misuse, and to meet the national policy objective of providing a treatment response to people with alcohol-related problems in contact with health services.
Collapse
Affiliation(s)
- Anthony O'Brien
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand.
| | | | | |
Collapse
|
40
|
Havard A, Shakeshaft AP, Conigrave KM. Prevalence and characteristics of patients with risky alcohol consumption presenting to emergency departments in rural Australia. Emerg Med Australas 2012; 24:266-76. [DOI: 10.1111/j.1742-6723.2012.01537.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
41
|
Havard A, Shakeshaft AP, Conigrave KM, Doran CM. Randomized controlled trial of mailed personalized feedback for problem drinkers in the emergency department: the short-term impact. Alcohol Clin Exp Res 2011; 36:523-31. [PMID: 22014309 DOI: 10.1111/j.1530-0277.2011.01632.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence exists for the efficacy of emergency department (ED)-based brief alcohol interventions, but attempts to incorporate face-to-face interventions into routine ED practice have been hampered by time, financial, and attitudinal constraints. Mailed personalized feedback, which is likely to be more feasible, has been associated with reduced alcohol consumption in other settings, but its cost-effectiveness in the ED has not been examined. METHODS The intervention was evaluated with a randomized controlled trial of patients presenting to 5 rural EDs in New South Wales, Australia. Patients aged 14 years and older were screened using the Alcohol Use Disorders Identification Test, and those scoring 8 or more were randomly allocated to the intervention or control group. Participants in the intervention group received mailed personalized feedback regarding their alcohol consumption. The control group received no feedback. RESULTS Two hundred and forty-four (80%) participants were successfully followed up at 6 weeks. A significant effect of the mailed feedback was observed only in patients with an alcohol-involved ED presentation. Among this subgroup of participants, those in the intervention group consumed 12.2 fewer drinks per week than the control group after controlling for baseline consumption and other covariates (effect size d = 0.59). The intervention was associated with an average cost of Australian $5.83 per patient, and among participants with an alcohol-involved ED presentation, an incremental cost-effectiveness ratio of 0.48. CONCLUSIONS Mailed personalized feedback is efficacious in reducing quantity/frequency of alcohol consumption among patients with alcohol-involved ED presentations. Mailed feedback has high cost-efficacy and a low absolute cost, making it a promising candidate for integration into ED care.
Collapse
Affiliation(s)
- Alys Havard
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | | | | | | |
Collapse
|
42
|
Fahy P, Croton G, Voogt S. Embedding routine alcohol screening and brief interventions in a rural general hospital. Drug Alcohol Rev 2011; 30:47-54. [PMID: 21219497 DOI: 10.1111/j.1465-3362.2010.00195.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
ISSUES Alcohol screening and brief intervention approaches (SBI) are strongly supported by evidence, but few health-care facilities have successfully introduced and sustained routine SBI. APPROACH This paper describes the first 2 years of implementing SBI in an Australian rural general hospital. The SBI project aims were to universally screen presentations to Northeast Health Wangaratta (NHW), to provide brief interventions to people screening at medium risk of harm from drinking and enhanced referral for persons screening at high risk. KEY FINDINGS In 2007 and 2008, the NHW SBI project conducted 11,079 screens for alcohol use disorders using the Alcohol Use Disorders Identification Screening Test screening tool. Eighty-five per cent of persons screened at low risk of alcohol-related problems, 11% at medium risk and 4% at high risk. IMPLICATIONS Policy and planning bodies and hospital management's support and the appointment of a dedicated project worker are critical to successful SBI implementation. CONCLUSION It is possible to establish a SBI service in a rural general hospital setting. The NHW SBI project broadened the focus from treatment of persons with severe dependency to detection, early intervention and prevention for the larger, more easily treated, cohort of persons drinking at hazardous/harmful but non-dependent levels. The challenge for any organisation is to maintain routine SBI deployment over the long term.
Collapse
Affiliation(s)
- Peter Fahy
- Professional Development Unit, Northeast Health Wangaratta, Wangaratta, Australia
| | | | | |
Collapse
|
43
|
Nehlin C, Fredriksson A, Jansson L. Brief alcohol screening in a clinical psychiatric population: special attention needed. Drug Alcohol Rev 2011; 31:538-43. [PMID: 21726312 DOI: 10.1111/j.1465-3362.2011.00333.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND AIMS Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single-item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment-seeking population. DESIGN AND METHODS Data were collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the heavy episodic drinking (HED) screener, AUDIT item # 3 (AUDIT-3) and the three consumption items of AUDIT (AUDIT-C) was compared to the result of the full 10-item AUDIT with cut-off points 6 for women and 8 for men. RESULTS The HED screener and AUDIT-3 with recommended cut-offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut-offs created rates far above those of the full AUDIT. AUDIT-C with recommended cut-off limits categorised nearly the same rates of men as the full AUDIT but much higher rates of women. Raising the cut-off for women approached the detection rate of AUDIT-C closely to that of the full AUDIT. DISCUSSION AND CONCLUSIONS The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health-care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.
Collapse
Affiliation(s)
- Christina Nehlin
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | | | | |
Collapse
|
44
|
Freeman T, Roche AM, Williamson P, Pidd K. Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour. Emerg Med Australas 2011; 23:479-89. [DOI: 10.1111/j.1742-6723.2011.01416.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Bjerregaard LBL, Gerke O, Rubak S, Høst A, Wagner L. Identifying parents with risky alcohol consumption habits in a paediatric unit--are screening and brief intervention appropriate methods? Scand J Caring Sci 2010; 25:383-93. [PMID: 21039719 DOI: 10.1111/j.1471-6712.2010.00838.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is no systematic identification of parents with excessive alcohol use who have a child admitted to hospital. Children in families with excessive alcohol issues form a high risk group as substantial alcohol consumption has a damaging influence on a child emotionally, cognitively, socially and physically. Alcohol consumption is a sensitive issue, and health staff needs knowledge, qualifications and adequate training in communicating with parents about this taboo. AIM • To identify specific patterns in subgroups of parents by comparing results from screening and demographic variables • To identify systematic patterns in staff members by demographic variables to decide whether these factors influence the screening results. METHODS During 1 year, screening and brief intervention (SBI) was accomplished, including health staff conducting dialogues with parents of a hospitalized child using motivational interviewing (MI) and screening for risky alcohol behaviour by Cut down, Annoyance from others, feel Guilty, Early-morning Craving (CAGE)-C. Data were analysed by descriptive statistics, and relationships were tested with a statistical significance level of 0.05, using SPSS (version 16.0). RESULTS Motivational dialogues with 779 parents were conducted by 43 staff members, and 11% of the parents were screened positive for risky alcohol behaviour. Drinking alcohol 4 days a week or more and drinking alcohol outside mealtimes were main risk factors. Parents' gender was the strongest predictor of screening positive and OR was 6.8 for men (CI 4.03-11.74) compared to women, p<0.0001. An OR of 1.2 for parents' age (CI 1.02-1.42) indicates the risk of screening positive increases with age, p=0.027. CONCLUSIONS Brief intervention using CAGE-C and MI has proven successful in mapping parents' alcohol consumption patterns and in identifying parents with risky alcohol consumption habits. Health staff is able to manage health promotion and prevention when having the right competences and when being supervised.
Collapse
Affiliation(s)
- Lene B L Bjerregaard
- Institute of Clinical Research, Research Unit of Clinical Nursing, the Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | | | | | | | | |
Collapse
|
46
|
Rosón B, Monte R, Gamallo R, Puerta R, Zapatero A, Fernández-Solá J, Pastor I, Girón JA, Laso J. Prevalence and routine assessment of unhealthy alcohol use in hospitalized patients. Eur J Intern Med 2010; 21:458-64. [PMID: 20816605 DOI: 10.1016/j.ejim.2010.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 04/09/2010] [Accepted: 04/16/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the prevalence of alcohol misuse among medical inpatients and the methods used by medical staff to evaluate alcohol consumption. METHODS Multicenter, prospective, observational, cross-sectional study performed at 21 hospitals in Spain. All adult patients hospitalized in internal medicine wards on 12 March 2008 were eligible for study. Alcohol consumption was evaluated with the Alcohol Use Disorders Identification Test (AUDIT-C and AUDIT) and the Systematic Inventory of Alcohol Consumption questionnaire. Drinking patterns were determined according to clinical evaluation using ICD-10 criteria. Medical records were reviewed to gather information on the recording of alcohol use. RESULTS We assessed 1039 inpatients, of whom 123 (12%) had unhealthy alcohol drinking patterns. Alcohol misuse was more frequent among males (odds ratio 5.20), younger patients (odds ratio, 14.17), median age patients (odds ratio, 2.99), and South Region (odds ratio, 1.77). Alcohol use during hospitalization was recorded in 603 inpatients (59%); quantitative records were performed in 28% of hazardous and harmful drinkers and in 41% of dependent patients. Lack of alcohol use recording was more frequent among females (odds ratio 1.73), median and older age groups (odds ratios 1.44 and 1.73, respectively), Northwest Regions (odds ratios 3.46). Patients from the East Region (odds ratio 0.47) had more frequently assessed the question in their medical records. CONCLUSIONS Prevalence of alcohol misuse was higher in hospitalized patients than in the general population. Adequate quantitative recording was infrequent. We stress the need to implement measures to increase and improve the detection and recording of alcohol use.
Collapse
Affiliation(s)
- Beatriz Rosón
- Hospital Universitario de Bellvitge, Feixa Llarga s/n., L'Hospitatel de Llobregat, Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
WILLIAMS MANDY, MOHSIN MOHAMMED, WEBER DANIELLE, JALALUDIN BIN, CROZIER JOHN. Alcohol consumption and injury risk: A case-crossover study in Sydney, Australia. Drug Alcohol Rev 2010; 30:344-54. [DOI: 10.1111/j.1465-3362.2010.00226.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
48
|
Most inpatients with unhealthy alcohol use have an alcohol use disorder. Int J Public Health 2010; 55:527-8; author reply 529-30. [DOI: 10.1007/s00038-010-0158-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
49
|
Freeman WM, Vrana KE. Future prospects for biomarkers of alcohol consumption and alcohol-induced disorders. Alcohol Clin Exp Res 2010; 34:946-54. [PMID: 20374220 DOI: 10.1111/j.1530-0277.2010.01169.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The lack of reliable measures of alcohol intake is a major obstacle to the diagnosis, treatment, and research of alcohol abuse and alcoholism. Successful development of a biomarker that allows for accurate assessment of alcohol intake and drinking patterns would not only be a major advance in clinical care but also a valuable research tool. A number of advances have been made in testing the validity of proposed biomarkers as well as in identifying potential new biomarkers through systems biology approaches. This commentary will examine the definition of a biomarker of heavy drinking, the types of potential biomarkers, the steps in biomarker development, the current state of biomarker development, and critical obstacles for the field. The challenges in developing biomarkers for alcohol treatment and research are similar to those found in other fields. However, the alcohol research field must reach a competitive level of rigor and organization. We recommend that NIAAA consider taking a leadership role in organizing investigators in the field and providing a common set of clinical specimens for biomarker validation studies.
Collapse
Affiliation(s)
- Willard M Freeman
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
| | | |
Collapse
|
50
|
Bischof G, Reinhardt S, Freyer-Adam J, Coder B, Grothues JM, Meyer C, John U, Rumpf HJ. Severity of unhealthy alcohol consumption in medical inpatients and the general population: is the general hospital a suitable place for brief interventions? Int J Public Health 2010; 55:637-43. [DOI: 10.1007/s00038-010-0122-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 04/02/2009] [Accepted: 01/13/2010] [Indexed: 11/29/2022] Open
|