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El-Menyar A, Mekkodathil A, Consunji R, Abeid A, Latifi R, Rizoli S, Al-Thani H. Implementation of mandatory blood alcohol screening in trauma patients: A retrospective study from a tertiary trauma center in a Middle Eastern country. Alcohol 2024; 119:7-15. [PMID: 38043650 DOI: 10.1016/j.alcohol.2023.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Alcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption. METHODS This was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as "negative", and BAC >2.2 mmol/L was referred to as "BAC positive". A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied. RESULTS A total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%-85.3%), and the test positivity rate was 10% (8.6%-12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS. CONCLUSION Despite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.
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Affiliation(s)
- Ayman El-Menyar
- Trauma Surgery Section, Clinical Research, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | | | - Rafael Consunji
- Trauma Surgery Section, Injury Prevention Program, HGH, Doha, Qatar
| | - Aisha Abeid
- Trauma Surgery Section, Injury Prevention Program, HGH, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States
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Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review. Drug Alcohol Rev 2024; 43:897-926. [PMID: 38316529 DOI: 10.1111/dar.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
ISSUE Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods. APPROACH Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs. KEY FINDINGS Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30). IMPLICATIONS AND CONCLUSION Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jia Y Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Sengupta S, Anand A, Lopez R, Weleff J, Wang PR, Bellar A, Attaway A, Welch N, Dasarathy S. Emergency services utilization by patients with alcohol-associated hepatitis: An analysis of national trends. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:98-109. [PMID: 38193831 PMCID: PMC10783841 DOI: 10.1111/acer.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Hospitalization and mortality in patients with alcohol-associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the emergency department (ED). However, there are no data on ED utilization by patients with AH. Thus, the Nationwide Emergency Department Sample (NEDS) dataset was analyzed to determine the ED utilization for AH. METHODS Temporal trends (2016-2019) and outcomes of ED visits for AH were determined. Primary or secondary AH diagnoses were based on coding priority. Numbers of patients evaluated in the ED, severity of disease, complications of liver disease, and discharge disposition were analyzed. Crude and adjusted rates were examined, and temporal trends evaluated using logistic regression with orthogonal polynomial contrasts for each year. RESULTS There were 466,014,370 ED visits during 2016-2019, of which 448,984 (0.096%) were for AH, 85.0% of which required hospitalization. The rate of visits for AH (primary and secondary) between 2016 and 2019 increased from 85 to 106.8/100,000 ED visits. The rate of secondary AH increased more than the rate of primary AH (from 68.6 to 86.5 vs. from 16.4 to 20.3/100,000 ED visits). Patients aged 45-64 years had the highest rate of ED visits for AH, which decreased during the study period, while the rate of ED visits for AH increased in those aged 25-44 years (from 38.5% to 42.9%). The severity of disease (ascites, hepatic encephalopathy, and acute kidney injury) also increased over time. Medicaid and private insurance were the most common payors for patients seeking care in the ED for AH. CONCLUSIONS Temporal trends show an overall increase in ED utilization rates for AH, more patients requiring hospitalization, and an increase in the proportion of younger patients presenting to the ED with AH.
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Affiliation(s)
- Shreya Sengupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rocio Lopez
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, USA
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - Philip R Wang
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Annette Bellar
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Attaway
- Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nicole Welch
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
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Blake H, Adams EJ, Chaplin WJ, Morris L, Mahmood I, Taylor MG, Langmack G, Jones L, Miller P, Coffey F. Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7028. [PMID: 37998259 PMCID: PMC10671475 DOI: 10.3390/ijerph20227028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, "Alcohol Prevention in Urgent and Emergency Care" (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative-participatory design approaches and a rigorous six-step ASPIRE methodology (involving n = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey (n = 18) and then participated in individual qualitative interviews (n = 15). Analysis of data was aligned with Levels 1-3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers' perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Emma J. Adams
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Wendy J. Chaplin
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lucy Morris
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Ikra Mahmood
- General Surgery Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Michael G. Taylor
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Gillian Langmack
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lydia Jones
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Philip Miller
- Health Innovation East Midlands, Nottingham NG7 2TU, UK;
| | - Frank Coffey
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
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Todd B, Rahm J, Kerley D, Hunt DL. Impact of a Rounding Tool and Clinical Champion on Trauma Patient Screening, Brief Intervention, and Referral to Treatment for Alcohol Use Disorder. J Trauma Nurs 2023; 30:346-352. [PMID: 37937876 DOI: 10.1097/jtn.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Early identification and treatment of alcohol misuse among trauma patients is the standard of care for trauma centers. Yet, trauma programs face significant barriers in adherence to sustained alcohol misuse screening. OBJECTIVE This study aims to evaluate the impact of a rounding tool and clinical champion on screening, brief intervention, and referral to treatment compliance rates for alcohol use disorder in trauma patients. METHODS This is a single-center, retrospective cohort design measuring the impact of a nursing rounding tool and clinical champion on screening, brief intervention, and referral to treatment for alcohol use disorder in trauma patients older than 14 years. Retrospective reviews were conducted over a 5-year period from 2017 to 2021 for all admitted trauma patients as defined by the National Trauma Data Standard. RESULTS More than 5,000 trauma patients were included during the study period. The nurses' rounding tool and clinical champion intervention led to an increase in the alcohol use disorder screening rate from an average of 59% for the first 3 months of the study (May to July 2017) to 95% for the last 3 months of the study (March to May 2021). CONCLUSION Our findings show that a dedicated clinical champion and nurse rounding tool increase compliance for screening, brief intervention, and referral to treatment for alcohol use disorder in trauma patients.
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Affiliation(s)
- Brandon Todd
- Department of Trauma, TriStar Skyline Medical Center, Nashville, Tennessee (Mr Todd, Ms Rahm, and Dr Hunt); and Department of Trauma, Sumner Regional Medical Center, Gallatin, Tennessee (Mr Kerley)
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Vaca FE, Dziura J, Abujarad F, Pantalon M, Hsiao A, Reynolds J, Maciejewski KR, Field CA, D’Onofrio G. Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2314848. [PMID: 37219901 PMCID: PMC10208138 DOI: 10.1001/jamanetworkopen.2023.14848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
Importance Alcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden. Objective To compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking. Design, Setting, and Participants This bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020. Intervention Patients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up. Main Outcomes and Measures The primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization. Results Among 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction). Conclusions and Relevance In this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities. Trial Registration ClinicalTrials.gov Identifier: NCT02247388.
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Affiliation(s)
- Federico E. Vaca
- Department of Emergency Medicine, University of California Irvine School of Medicine, Orange
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Fuad Abujarad
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Allen Hsiao
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jesse Reynolds
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | | | - Craig A. Field
- Latino Health Disparities Research, University of Texas at El Paso, El Paso
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Ware OD, Buresh ME, Irvin NA, Stitzer ML, Sweeney MM. Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100093. [PMID: 36644224 PMCID: PMC9835716 DOI: 10.1016/j.dadr.2022.100093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 01/19/2023]
Abstract
Introduction Brief intervention with peer recovery coach support has been used to generate referrals to substance use disorder treatment from the emergency department (ED). This retrospective study evaluated factors associated with successful linkage to treatment following brief intervention in the ED. Methods Data were extracted from the electronic health record for patients who were referred to substance use treatment from the ED and for whom follow-up data regarding treatment attendance was available (n=666). We examined associations between demographic and insurance variables, substance use, mental health diagnosis, prior abstinence, and stage of change with successful linkage to substance use treatment after ED referral. Results The sample was majority male (68%), White (62%), and had a mean age of 43 years (SD=12). Medicaid was the most common insurance (49%) followed by employer/private (34%). Multivariable logistic regression determined patients with Medicaid (OR=2.94, 95% CI:2.09-4.13, p=<.001), those who had a documented alcohol use disorder diagnosis (OR=1.59, 95% CI:1.074-2.342, p=.02), and those in the "Action" stage of change (OR=2.33, 95% CI:1.47-3.69, p=<.001) had greater odds of being successfully linked to treatment. Conclusions These results identify characteristics of patients available in the health record to determine who is more likely or less likely to attend substance use treatment following ED referral. Given appropriate screening, this information could be used to direct standard care resources to those with high likelihood of treatment attendance and strengthen follow-up interventions with peer recovery coaches for those with lower likelihood of treatment attendance.
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Affiliation(s)
- Orrin D. Ware
- School of Social Work, The University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC 27599, USA
| | - Megan E. Buresh
- Johns Hopkins University School of Medicine
- Department of Medicine, Division of Addiction Medicine, 5200 Mason F. Lord Drive, Baltimore, MD 21224, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nathan A. Irvin
- Johns Hopkins University School of Medicine
- Department of Emergency Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Maxine L. Stitzer
- Johns Hopkins University School of Medicine
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
- Friends Research Institute, 1040 Park Avenue, Baltimore, MD 21201, USA
| | - Mary M. Sweeney
- Johns Hopkins University School of Medicine
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Crilly J, East K, Brown J, Zhang P, Byrnes J, Furyk J, Duncan J, Jones L, Brown NJ, Green D, Rothwell S, Rosengren D. The profile, clinical characteristics, and outcomes of alcohol- and non-alcohol-related patient presentations to Queensland emergency departments: a multi-site observational study. AUST HEALTH REV 2022; 46:701-709. [PMID: 36450160 DOI: 10.1071/ah22161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/03/2022] [Indexed: 12/02/2022]
Abstract
Objective The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18-22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9-5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64-75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs.
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Affiliation(s)
- Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Qld, Australia; and School of Nursing and Midwifery, Griffith University, Qld, Australia; and Menzies Health Institute Queensland, Griffith University, Qld, Australia
| | - Katie East
- Department of Emergency Medicine, Metro South Hospital and Health Service, Qld, Australia
| | - Josea Brown
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Qld, Australia
| | - Ping Zhang
- Menzies Health Institute Queensland, Griffith University, Qld, Australia
| | - Josh Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Qld, Australia
| | - Jeremy Furyk
- Department of Emergency Medicine, University Hospital Geelong, Vic., Australia; and Faculty of Health, Deakin University, Vic., Australia
| | - Jill Duncan
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Qld, Australia
| | - Leonie Jones
- Emergency Department, Townsville University Hospital, Townsville, Qld, Australia
| | - Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Qld, Australia; and Faculty of Medicine, The University of Queensland, Qld, Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Qld, Australia; and Menzies Health Institute Queensland, Griffith University, Qld, Australia
| | - Sean Rothwell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Qld, Australia
| | - David Rosengren
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Qld, Australia; and Faculty of Medicine, The University of Queensland, Qld, Australia
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Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial. J Addict Med 2022:01271255-990000000-00109. [PMID: 36300816 DOI: 10.1097/adm.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In this study, we aimed to examine the prevalence of alcohol consumption among methadone maintenance treatment (MMT) clients in Shanghai and to determine whether a brief intervention (BI) affects drinking among them. METHODS A total of 837 clients from 14 local MMT clinics were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). One hundred one were included in the study and randomly assigned to the BI group or the control group. Clients in the BI group received a BI and general health education, whereas clients in the control group received the general health education only. Baseline and postintervention assessments were conducted by using the AUDIT, the Drinking Attitude Questionnaire, the Depression Module of the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the General Well-Being Schedule. RESULTS Two hundred fifty-nine (30.9%) reported drinking during the last year, and 103 (12.3%) met the criteria for harmful use. At the 3-month follow-up, the AUDIT scores of the 2 groups were significantly decreased, and the time effect was statistically significant ( F = 6.224, P = 0.018), but there was no group difference in AUDIT scores ( F = 1.953, P = 0.172). Both groups had a main time effect of time on the improvement of depression ( F = 8.044, P = 0.008), anxiety ( F = 9.650, P = 0.004), and general well-being ( F = 5.056, P = 0.033). However, there was no statistical difference between the 2 groups ( P > 0.05), and no statistical difference in the time ( F = 1.738, P = 0.198) and group ( F = 0.658, P = 0.424) effect of drinking attitude. CONCLUSIONS Alcohol consumption is common among MMT clients in China. Brief intervention, in its current form, could not effectively help them reduce their alcohol consumption.
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Reif S, Brolin M, Beyene TM, D’Agostino N, Stewart MT, Horgan CM. Payment and Financing for Substance Use Screening and Brief Intervention for Adolescents and Adults in Health, School, and Community Settings. J Adolesc Health 2022; 71:S73-S82. [PMID: 36122974 PMCID: PMC9945348 DOI: 10.1016/j.jadohealth.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 10/14/2022]
Abstract
Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address unhealthy substance use. With SBI services expanding beyond healthcare settings (e.g., schools, community organizations) and reaching younger populations, sustainability efforts must consider payment and financing. This narrative review incorporated rapid scoping review methods and a search of the gray literature to determine payment and financing approaches for SBI with adolescents and to describe related barriers and facilitators for its sustainability. We sought information relevant to adolescents and settings in which they receive SBI, but also reviewed sources with an adult focus. Few peer-reviewed articles met inclusion criteria, and those mostly highlighted healthcare settings. School-based settings were better described in the gray literature; little was found about community settings. SBI is mostly paid through grant funding and public and commercial insurance; school-based settings use a range of approaches including grants, public insurance, and other public funding. We call upon researchers and providers to describe the payment and financing of SBI, to inform how the uptake of SBI may be practicable and sustainable. The increasing activation and use of insurance billing codes, and the expansion of SBI beyond healthcare, is encouraging to address unhealthy substance use by adolescents.
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Affiliation(s)
- Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Mary Brolin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Tiginesh M. Beyene
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Nicole D’Agostino
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Maureen T. Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Constance M. Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Chartier KG, Bares CB, Prom-Wormley EC, Blondino C, Miles K, Lee AG, Karriker-Jaffe KJ. Effects of family history of alcohol problems on alcohol consumption: Stronger for medically underserved men. Prev Med 2022; 161:107093. [PMID: 35597304 DOI: 10.1016/j.ypmed.2022.107093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Family history (FH), informed by genetics and family environment, can be used by practitioners for risk prediction. This study compares the associations of FH with alcohol outcomes for medically underserved (MUS) men and women with the associations for non-underserved individuals to assess the utility of FH as a screening tool for this high-priority group. Data were from 29,993 adult lifetime drinkers in the Wave 1 (2001-2002) and Wave 2 (2004-2005) National Epidemiologic Survey on Alcohol and Related Conditions. All variables except FH were measured at Wave 2. Dependent variables were 12-month alcohol consumption and alcohol use disorder (AUD). FH scores (FH-SCORE) measured the proportion of first- and second-degree biological relatives with alcohol problems. MUS status was defined by household income at or below 100% of the federal poverty line and participants reporting no usual source of health care. Multivariate linear and logistic regression models tested main and interaction effects. Models showed a significant interaction of FH-SCORE with MUS status (p < .01), with a stronger effect of FH on alcohol consumption for the MUS group. This moderating effect was weaker for women than for men (FH-SCORE x MUS x Sex three-way interaction: p < .01). AUD models showed a significant positive association with FH-SCORE (p < .001) but no association with MUS status and no significant interaction effects. In this sample of lifetime drinkers, FH was associated with higher alcohol consumption, especially for MUS men. These results encourage additional validation of FH scores to prioritize MUS adults at high risk for alcohol problems to receive preventive interventions.
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Affiliation(s)
- Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Cristina B Bares
- School of Social Work, The University of Michigan, Ann Arbor, MI, United States of America
| | - Elizabeth C Prom-Wormley
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Courtney Blondino
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Kia Miles
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Anna G Lee
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Katherine J Karriker-Jaffe
- Center for Behavioral Health Epidemiology, Implementation & Evaluation Research, RTI International, Berkeley, CA, United States of America
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Merianos AL, Fiser KA, Mahabee-Gittens EM, Lyons MS, Gordon JS. Barriers to implementation of pediatric emergency department interventions for parental tobacco use and dependence: a qualitative study using the theoretical domains framework. Implement Sci Commun 2022; 3:3. [PMID: 35022066 PMCID: PMC8754362 DOI: 10.1186/s43058-021-00251-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pediatric emergency department (PED) and urgent care (UC) professionals can play a key role in delivering evidence-based guidelines to address parental tobacco use and child tobacco smoke exposure (TSE). Understanding PED/UC professionals’ perceptions regarding these guidelines is the first step in developing and implementing a TSE screening and counseling intervention in these settings. This study aimed to use the theoretical domains framework (TDF) to identify current screening and counseling behaviors of PED/UC professionals related to parental tobacco use and child TSE, and determine barriers and enablers that influence these behaviors. Methods Semi-structured, focused interviews were conducted with 29 actively practicing PED/UC clinical staff who worked at one large, Midwestern children’s hospital. The interview guide was informed by the TDF and included open-ended questions. Content analysis of interview transcripts was guided by the TDF. Nurses, physicians, and healthcare administrators were assessed overall and by group membership to ensure each group was represented based on their varying PED/UC roles. Results Fifty-one percent were nurses, 38% were physicians, and 11% were healthcare administrators. Most PED/UC professionals did not currently follow the guidelines, but perceived addressing parental tobacco use as part of their role. All 14 TDF domains were identified by nurses, physicians, and administrators in relation to counseling for parental tobacco use and child TSE. Domains with the most sub-themes were (1) knowledge: lack of knowledge about tobacco counseling, including implementing counseling, cessation resources/referrals, and thirdhand smoke; (2) beliefs about capabilities: not comfortable counseling parents, easier to discuss with parents who are receptive and to ask and advise when patients have a TSE-related complaint, and more likely to discuss if there were resources/referrals; and (3) environmental context and resources: barriers include lack of time, training, and resources and referral information to give to parents, and an enabler is using TSE-related complaints as a context to offer counseling. Conclusions Study findings provide a strong foundation for developing and implementing clinical practice guidelines regarding parental tobacco use and child TSE in the PED/UC setting. Future intervention development will address all TDF domains and test the implementation of the intervention in the PED/UC setting.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH, 45221-0068, USA. .,Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kayleigh A Fiser
- School of Human Services, University of Cincinnati, P.O. Box 210068, Cincinnati, OH, 45221-0068, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, College of Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Michael S Lyons
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Department of Emergency Medicine, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0769, USA
| | - Judith S Gordon
- College of Nursing, The University of Arizona, 1305 N Martin Avenue, PO Box 210203, Tucson, AZ, 85721-0203, USA
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Abstract
Unhealthy alcohol and drug use are among the top 10 causes of preventable death in the United States, but they are infrequently identified and addressed in medical settings. Guidelines recommend screening adult primary care patients for alcohol and drug use, and routine screening should be a component of high-quality clinical care. Brief, validated screening tools accurately detect unhealthy alcohol and drug use, and their thoughtful implementation can facilitate adoption and optimize the quality of screening results. Recommendations for implementation include patient self-administered screening tools, integration with electronic health records, and screening during routine primary care visits.
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Affiliation(s)
- Jennifer McNeely
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine, New York, NY 10016, USA.
| | - Leah Hamilton
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA
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