Alcohol screening and simple advice in emergency care : staffs’ attitudes and injured patients’ drinking pattern

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