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Lau G, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Cameron P, Read DJ, Beck B. Association between acute pre-injury alcohol use and 12-month health outcomes for survivors of major trauma: A registry-based study. Injury 2024; 55:111782. [PMID: 39154490 DOI: 10.1016/j.injury.2024.111782] [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: 03/27/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Alcohol is commonly detected in patients presenting to hospital after major trauma and is a key preventable risk factor for injury. While it has been suggested that alcohol intoxication at the time of injury results in worse acute patient outcomes, there is currently limited knowledge on the impact of alcohol on health outcomes following hospital discharge. The aim of this study was to examine the relationship between acute pre-injury alcohol exposure and the self-reported health outcomes of survivors of major trauma 12-months post-injury. METHODS Data from the Victorian State Trauma Registry (January 1, 2018 to December 31, 2020) were used to identify major trauma patients who: (1) were aged ≥18 years; (2) survived to 12-months post-injury; and (3) had blood alcohol data available in the registry. Logistic regression analyses were used to examine differences in self-reported health status (EQ-5D) and return to work at 12-months post-injury by blood alcohol concentration (BAC) at the time of presentation to hospital. Analyses were adjusted for potential confounders including a range of demographic, hospital and injury characteristics. RESULTS A total of 2957 patients met inclusion criteria, of which 857 (29.0 %) had a BAC >0 and 690 (23.3 %) had a BAC ≥0.05 g/100 mL. After adjusting for potential confounders, having any alcohol detected (i.e., BAC >0) was associated with lower odds of reporting problems on the EQ-5D mobility (aOR = 0.72, 95 %CI = 0.53 to 0.99) and usual activities dimensions (aOR = 0.79, 95 %CI = 0.63 to 0.99). Having a BAC ≥0.05 g/100 mL was only associated with lower adjusted odds of reporting problems on the usual activities dimension (aOR = 0.69, 95 %CI = 0.55 to 0.88) of the EQ-5D. Alcohol detection was not associated with the self-care, pain/discomfort or anxiety/depression dimensions of the EQ-5D, or with return to work in adjusted analyses. CONCLUSION Acute pre-injury alcohol exposure was not associated with increased reporting of problems on the EQ-5D or with return to work at 12-months post-injury. Further research is needed to understand why patients with alcohol detections were sometimes associated with paradoxically better 12-month post-injury outcomes relative to patients without alcohol detections.
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Affiliation(s)
- Georgina Lau
- 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
- Behaviours and Health Risks 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
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - David J Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Lau G, Mitra B, Gabbe BJ, Dietze PM, Reeder S, Cameron PA, Smit DV, Schneider HG, Symons E, Koolstra C, Stewart C, Beck B. Prevalence of alcohol and other drug detections in non-transport injury events. Emerg Med Australas 2024; 36:78-87. [PMID: 37717234 PMCID: PMC10952644 DOI: 10.1111/1742-6723.14312] [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: 06/10/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To measure the prevalence of alcohol and/or other drug (AOD) detections in suspected major trauma patients with non-transport injuries who presented to an adult major trauma centre. METHODS This registry-based cohort study examined the prevalence of AOD detections in patients aged ≥18 years who: (i) sustained non-transport injuries; and (ii) met predefined trauma call-out criteria and were therefore managed by an interdisciplinary trauma team between 1 July 2021 and 31 December 2022. Prevalence was measured using routine in-hospital blood alcohol and urine drug screens. RESULTS A total of 1469 cases met the inclusion criteria. Of cases with a valid blood test (n = 1248, 85.0%), alcohol was detected in 313 (25.1%) patients. Of the 733 (49.9%) cases with urine drug screen results, cannabinoids were most commonly detected (n = 103, 14.1%), followed by benzodiazepines (n = 98, 13.4%), amphetamine-type substances (n = 80, 10.9%), opioids (n = 28, 3.8%) and cocaine (n = 17, 2.3%). Alcohol and/or at least one other drug was detected in 37.4% (n = 472) of cases with either a blood alcohol or urine drug test completed (n = 1263, 86.0%). Multiple substances were detected in 16.6% (n = 119) of cases with both blood alcohol and urine drug screens (n = 718, 48.9%). Detections were prevalent in cases of interpersonal violence (n = 123/179, 68.7%) and intentional self-harm (n = 50/106, 47.2%), and in those occurring on Friday and Saturday nights (n = 118/191, 61.8%). CONCLUSION AOD detections were common in trauma patients with non-transport injury causes. Population-level surveillance is needed to inform prevention strategies that address AOD use as a significant risk factor for serious injury.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Biswadev Mitra
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Emergency and Trauma CentreThe Alfred HospitalMelbourneVictoriaAustralia
| | - Belinda J Gabbe
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Health Data Research UK, Swansea University Medical SchoolSwansea UniversitySwanseaUK
| | - Paul M Dietze
- Disease Elimination Program, Burnet InstituteMelbourneVictoriaAustralia
- National Drug Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
| | - Sandra Reeder
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Peter A Cameron
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Emergency and Trauma CentreThe Alfred HospitalMelbourneVictoriaAustralia
| | - De Villiers Smit
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Emergency and Trauma CentreThe Alfred HospitalMelbourneVictoriaAustralia
- National Trauma Research InstituteThe Alfred HospitalMelbourneVictoriaAustralia
| | - Hans G Schneider
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of PathologyThe Alfred HospitalMelbourneVictoriaAustralia
| | - Evan Symons
- Alfred Mental and Addiction HealthThe Alfred HospitalMelbourneVictoriaAustralia
| | - Christine Koolstra
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Emergency and Trauma CentreThe Alfred HospitalMelbourneVictoriaAustralia
| | - Cara Stewart
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Emergency and Trauma CentreThe Alfred HospitalMelbourneVictoriaAustralia
| | - Ben Beck
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Lau G, Gabbe B, Mitra B, Dietze P, Reeder S, Cameron P, Read DJ, Symons E, Beck B. Biases in the collection of blood alcohol data for adult major trauma patients in Victoria, Australia. Emerg Med J 2023; 40:744-753. [PMID: 37562944 DOI: 10.1136/emermed-2023-213186] [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: 02/28/2023] [Accepted: 06/09/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In-hospital alcohol testing provides an opportunity to implement prevention strategies for patients with high risk of experiencing repeated alcohol-related injuries. However, barriers to alcohol testing in emergency settings can prevent patients from being tested. In this study, we aimed to understand potential biases in current data on the completion of blood alcohol tests for major trauma patients at hospitals in Victoria, Australia. METHODS Victorian State Trauma Registry data on all adult major trauma patients from 1 January 2018 to 31 December 2021 were used. Characteristics associated with having a blood alcohol test recorded in the registry were assessed using logistic regression models. RESULTS This study included 14 221 major trauma patients, of which 4563 (32.1%) had a blood alcohol test recorded. Having a blood alcohol test completed was significantly associated with age, socioeconomic disadvantage level, preferred language, having pre-existing mental health or substance use conditions, smoking status, presenting during times associated with heavy community alcohol consumption, injury cause and intent, and Glasgow Coma Scale scores (p<0.05). Restricting analyses to patients from a trauma centre where blood alcohol testing was part of routine clinical care mitigated most biases. However, relative to patients injured while driving a motor vehicle/motorcycle, lower odds of testing were still observed for patients with injuries from flames/scalds/contact burns (adjusted OR (aOR)=0.33, 95% CI 0.18 to 0.61) and low falls (aOR=0.17, 95% CI 0.12 to 0.25). Higher odds of testing were associated with pre-existing mental health (aOR=1.39, 95% CI 1.02 to 1.89) or substance use conditions (aOR=2.33, 95% CI to 1.47-3.70), and living in a more disadvantaged area (most disadvantaged quintile relative to least disadvantaged quintile: aOR=2.30, 95% CI 1.52 to 3.48). CONCLUSION Biases in the collection of blood alcohol data likely impact the surveillance of alcohol-related injuries. Routine alcohol testing after major trauma is needed to accurately inform epidemiology and the subsequent implementation of strategies for reducing alcohol-related injuries.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Paul Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - David J Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Evan Symons
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Baker T, Taylor N, Kloot K, Miller P, Egerton‐Warburton D, Shepherd J. Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia. Aust J Rural Health 2023; 31:532-539. [PMID: 37078513 PMCID: PMC10947014 DOI: 10.1111/ajr.12983] [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: 07/25/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. OBJECTIVE This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED. DESIGN From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations. FINDINGS ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = -0.004, p = 0.044). No other significant results were found. DISCUSSION Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. CONCLUSION This intervention continues to have promise for reducing alcohol-related harm.
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Affiliation(s)
- Tim Baker
- Centre for Rural Emergency Medicine, Faculty of HealthDeakin UniversityWarrnamboolVictoriaAustralia
- South West HealthcareWarrnamboolVictoriaAustralia
| | - Nicholas Taylor
- School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
- National Drug Research InstituteCurtin UniversityPerthVictoriaAustralia
| | - Kate Kloot
- South West HealthcareWarrnamboolVictoriaAustralia
- School of MedicineDeakin UniversityWarrnamboolVictoriaAustralia
| | - Peter Miller
- School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
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Miller P, Vakidis T, Taylor N, Baker T, Stella J, Egerton-Warburton D, Hyder S, Staiger P, Bowe SJ, Shepherd J, Zordan R, Walby A, Jones ML, Caldicott D, Barker D, Hall M, Doran CM, Ezard N, Preisz P, Havard A, Shakeshaft A, Akhlaghi H, Kloot K, Lowry N, Bumpstead S. Most common principal diagnoses assigned to Australian emergency department presentations involving alcohol use: a multi-centre study. Aust N Z J Public Health 2022; 46:903-909. [PMID: 36121276 DOI: 10.1111/1753-6405.13303] [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: 12/01/2021] [Revised: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia. METHODS Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area. RESULTS ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females. CONCLUSIONS Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide. IMPLICATIONS FOR PUBLIC HEALTH The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.
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Affiliation(s)
- Peter Miller
- School of Psychology, Deakin University, Victoria
| | - Thea Vakidis
- School of Psychology, Deakin University, Victoria
| | - Nicholas Taylor
- School of Psychology, Deakin University, Victoria.,National Drug Research Institute, Curtin University, Victoria
| | - Tim Baker
- Centre for Rural Emergency Medicine, Faculty of Health, Deakin University, Victoria.,South West Healthcare, Victoria
| | | | | | | | | | | | - Jonathan Shepherd
- Crime and Security Research Institute, Cardiff University, Wales, UK
| | - Rachel Zordan
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | | | - Martyn Lloyd Jones
- VMO Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria.,Alfred Addiction and Mental Health, the Alfred Hospital, Victoria
| | | | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | | | - Christopher M Doran
- Cluster for Resilience and Well-being, Appleton Institute, Central Queensland University, Queensland
| | - Nadine Ezard
- St Vincent's Hospital Sydney, National Centre for Clinical Research on Emerging Drugs, New South Wales.,National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales
| | - Paul Preisz
- St Vincent's Hospital Darlinghurst, New South Wales.,Faculty of Medicine & Health, UNSW Sydney, New South Wales.,School of Medicine, University Notre Dame, New South Wales
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales.,Centre for Big Data Research in Health, UNSW Sydney, New South Wales
| | | | - Hamed Akhlaghi
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | - Kate Kloot
- School of Medicine, Deakin University, Victoria
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Hullenaar KL, Lyons VH, Shepherd JP, Rowhani-Rahbar A, Vavilala MS, Rivara FP. Assault-related injuries reported to police and treated by healthcare providers in the United States. Prev Med 2022; 159:107060. [PMID: 35460720 DOI: 10.1016/j.ypmed.2022.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Abstract
Research suggests that assault-related injuries known by the police significantly differ from those known by healthcare providers, but the magnitude and nature of these differences are poorly understood. To address this gap, our study examined the empirical differences between assault-related injuries reported to police and treated by healthcare providers. In June of 2021, we analyzed the National Crime Victimization Survey (1993-2019) to estimate the prevalence of police reporting and healthcare use among 5093 nonfatal victimizations that caused injury and were either reported to the police or treated by healthcare in the United States. Quasi-Poisson models identified the factors associated with whether people who sustained the injuries used healthcare (v. only reported to police) and reported to police (v. only used healthcare). Among victimizations that caused only minor injuries, 43% involved only a police report, 11% involved only healthcare, and 46% involved both services. Among victimizations that caused serious injuries, 14% involved only a police report, 13% involved only healthcare, and 73% involved both services. Whether people with violent injuries used healthcare (v. only reported to police) and reported to police (v. only used healthcare) was significantly associated with 13 different person- and incident-level factors. The number and nature of assault-related injuries reported to law enforcement significantly differ from those treated by healthcare providers. Therefore, public health efforts to link police and healthcare data are warranted and recommended.
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Affiliation(s)
- Keith L Hullenaar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Epidemiology, University of Washington, Seattle, WA, United States of America.
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States of America
| | - Jonathan P Shepherd
- Crime and Security Research Institute, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States of America
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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Zhang J, Qian S, Su G, Deng C, Reid D, Curtis K, Sinclair B, Yu P. Emergency department presentations of patients with alcohol use disorders in an Australian regional health district. Subst Abus 2022; 43:1126-1138. [DOI: 10.1080/08897077.2022.2060427] [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]
Affiliation(s)
- Jingxiang Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Guoxin Su
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Chao Deng
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - David Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Kate Curtis
- Illawarra Health and Medical Research Institute, Wollongong, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Barbara Sinclair
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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Livingston M, Coomber K, de Andrade D, Taylor N, Ferris J, Puljević C, Miller PG. Assessing the impact of Queensland's late-night alcohol restrictions using health system data. Drug Alcohol Rev 2021; 40:698-707. [PMID: 34008874 DOI: 10.1111/dar.13182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/03/2020] [Accepted: 08/22/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS In an attempt to reduce alcohol-related harm in night-time entertainment precincts, the Queensland state government (Australia) introduced the Tackling Alcohol-Fuelled Violence strategy in July 2016, including restrictions on late-night service of alcohol and-later-compulsory ID scanners at venues. In this article, we examined the impact of these changes on emergency department (ED) presentations and hospital admissions for alcohol-related harm. DESIGN AND METHODS We used data on ED presentations (July 2009-June 2019) and hospital admissions (July 2009-December 2018). Interrupted time series models using seasonal auto-regressive integrated moving average methods were developed to test the impact of the policy change on presentations for alcohol intoxication, any injury or maxillofacial fractures, and admissions for rates of assault-related injuries or maxillofacial fractures. Analyses were conducted using state-wide Queensland data with a sub-analysis focussing on major Brisbane hospitals. RESULTS The introduction of 3 am last drinks and mandatory ID scanners had no significant impact on most outcome measures, either across the state or within Brisbane. State-wide, there was a significant decline in ED injury presentations following the introduction of mandatory ID scanners. DISCUSSION AND CONCLUSIONS The introduction of the Tackling Alcohol-Fuelled Violence strategy in Queensland Safe Night Precincts was potentially associated with a small reduction in injury presentations to EDs. The lack of other impacts may relate to the relative lack of specificity in health system data, which challenges in the implementation of the Tackling Alcohol-Fuelled Violence policies or other local factors.
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Affiliation(s)
- Michael Livingston
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Kerri Coomber
- School of Psychology, Deakin University, Geelong, Australia
| | - Dominique de Andrade
- School of Psychology, Deakin University, Geelong, Australia.,School of Psychology, University of Queensland, Brisbane, Australia
| | | | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Cheneal Puljević
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Peter G Miller
- School of Psychology, Deakin University, Geelong, Australia.,National Drug Research Institute, Curtin University, Perth, Australia.,Menzies School of Health Research, Darwin, Australia
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Lung T, Si L, Hooper R, Di Tanna GL. Health Economic Evaluation Alongside Stepped Wedge Trials: A Methodological Systematic Review. PHARMACOECONOMICS 2021; 39:63-80. [PMID: 33015754 DOI: 10.1007/s40273-020-00963-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently, there has been an increase in use of the stepped wedge trial (SWT) design in the context of health services research, due to its pragmatic and methodological advantages over the parallel group design. OBJECTIVE Our objective was to summarise the statistical methods used when conducting economic evaluations alongside SWTs. METHODS A systematic literature search extending to February 2020 was conducted in the PubMed, Scopus, Cochrane and National Health Service Economic Evaluation Database (NHS-EED) databases to find and evaluate studies where there was an intention to conduct an economic evaluation alongside an SWT. Studies were assessed for their eligibility, findings, reporting of statistical methods and quality of reporting. RESULTS Of the 586 studies retrieved from the literature search, 69 studies were identified and included in this systematic review. A total of 54 studies were published protocols, with eight economic evaluations and seven studies reporting full trial results. Included studies varied in terms of their reporting of statistical methods, in both detail and methodology. There were 34 studies that did not report any statistical methods for the economic evaluation, and only 16 studies reported appropriate methods, mainly using some form of mixed/multilevel model, and two used seemingly unrelated regression. Twelve studies reported the use of generic bootstrap methods and other modelling techniques, whilst the remaining studies failed to appropriately account for clustering, correlation or adjustment for time. CONCLUSIONS The use of appropriate statistical methods that account for time, clustering and correlation between costs and outcomes is an important part of SWT health economics analysis, one that will benefit from an effort to communicate the methods available and their performance.
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Affiliation(s)
- Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
- Faculty of Medicine and Health, School of Public Health, Edward Ford Building A27, University of Sydney, Sydney, NSW, 2006, Australia
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Richard Hooper
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2042, Australia.
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