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      Critical Role of General Practitioners in Preventing Readmission Following Emergency Department Alcohol Screening and Brief Intervention Management of Alcohol-Related Problems

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          Abstract

          Introduction/Objectives:

          Alcohol screening and brief intervention (ASBI) strategies are useful in general practice (GP) but their effectiveness in the emergency department (ED) is unclear. We evaluated the effect of ED-based ASBI on re-admissions.

          Methods:

          453 ED subjects exceeding the threshold score on the three-item Alcohol Use Disorders Identification Test-Consumption (females 3+: males 4+) were randomized. We conducted telephone follow-up at 1 and 3 months and recorded hospital events 6 months pre- and post-enrolment.

          Results:

          Median weekly alcohol use was 20 standard drinks (interquartile range (IQR) 9-45) on enrolment. After 3 months, 247 (55%) were able to be re-interviewed. Median alcohol use was 10 drinks (IQR 4-26). Six months later, subjects receiving ED-ASBI without GP follow-up had significantly greater risk of re-admission compared with those having GP follow-up (OR 1.68, 95%CI 1.06-2.65; P = .028).

          Conclusions:

          ASBI reduces the likelihood of ED re-presentation only in subjects who have GP follow-up. The study has been registered as a clinical trial (Australian and New Zealand Clinical Trial Registry ACTRN12617001254381).

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          Most cited references17

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          The alcohol use disorders identification test: an update of research findings.

          Duane F. Reinert, John P. Allen (2007)
          The Alcohol Use Disorders Identification Test (AUDIT) has been extensively researched to determine its capability to accurately and practically screen for alcohol problems. During the 5 years since our previous review of the literature, a large number of additional studies have been published on the AUDIT, abbreviated versions of it, its psychometric properties, and the applicability of the AUDIT for a diverse array of populations. The current article summarizes new findings and integrates them with results of previous research. It also suggests some issues that we believe are particularly in need of further study. A growing body of research evidence supports the criterion validity of English version of the AUDIT as a screen for alcohol dependence as well as for less severe alcohol problems. Nevertheless, the cut-points for effective detection of hazardous drinking as well as identification of alcohol dependence or harmful use in women need to be lowered from the originally recommended value of 8 points. The AUDIT-C, the most popular short version of the AUDIT consisting solely of its 3 consumption items, is approximately equal in accuracy to the full AUDIT. Psychometric properties of the AUDIT, such as test-retest reliability and internal consistency, are quite favorable. Continued research is urged to establish the psychometric properties of non-English versions of the AUDIT, use of the AUDIT with adolescents and with older adults, and selective inclusion of alcohol biomarkers with the AUDIT in some instances. Research continues to support use of the AUDIT as a means of screening for the spectrum of alcohol use disorders in various settings and with diverse populations.
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            Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement.

            V Moyer, (2013)
            Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening and behavioral counseling interventions in primary care to reduce alcohol misuse. The USPSTF reviewed new evidence on the effectiveness of screening for alcohol misuse for improving health outcomes, the accuracy of various screening approaches, the effectiveness of various behavioral counseling interventions for improving intermediate or long-term health outcomes, the harms of screening and behavioral counseling interventions, and influences from the health care system that promote or detract from effective screening and counseling interventions for alcohol misuse. These recommendations apply to adolescents aged 12 to 17 years and adults aged 18 years or older. These recommendations do not apply to persons who are actively seeking evaluation or treatment of alcohol misuse. The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. (Grade B recommendation)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse in adolescents. (I statement)
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              How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis

              Lucy Platt, G J Melendez-Torres, Amy Jane O’Donnell … (2016)
              Background While the efficacy and effectiveness of brief interventions for alcohol (ABI) have been demonstrated in primary care, there is weaker evidence in other settings and reviews do not consider differences in content. We conducted a systematic review to measure the effect of ABIs on alcohol consumption and how it differs by the setting, practitioner group and content of intervention. Methods We searched MEDLINE, EMBASE, PsycINFO; CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015 for randomised controlled trials that measured effectiveness of ABIs on alcohol consumption. We grouped outcomes into measures of quantity and frequency indices. We used multilevel meta-analysis to estimate pooled effect sizes and tested for the effect of moderators through a multiparameter Wald test. Stratified analysis of a subset of quantity and frequency outcomes was conducted as a sensitivity check. Results 52 trials were included contributing data on 29 891 individuals. ABIs reduced the quantity of alcohol consumed by 0.15 SDs. While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses. Interventions delivered by nurses had the most effect in reducing quantity (d=−0.23, 95% CI (−0.33 to −0.13)) but not frequency of alcohol consumption. All content groups had statistically significant mean effects, brief advice was the most effective in reducing quantity consumed (d=−0.20, 95% CI (−0.30 to −0.09)). Effects were maintained in the stratified sensitivity analysis at the first and last assessment time. Conclusions ABIs play a small but significant role in reducing alcohol consumption. Findings show the positive role of nurses in delivering interventions. The lack of evidence on the impact of content of intervention reinforces advice that services should select the ABI tool that best suits their needs.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Prim Care Community Health
                Journal ID (iso-abbrev): J Prim Care Community Health
                Journal ID (publisher-id): JPC
                Journal ID (hwp): spjpc
                Title: Journal of Primary Care & Community Health
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 2150-1319
                ISSN (Electronic): 2150-1327
                Publication date (Electronic): 22 June 2021
                Publication date Collection: Jan-Dec 2021
                Volume: 12
                Electronic Location Identifier: 21501327211027437
                Affiliations
                [1 ]Fiona Stanley Hospital, Murdoch, Western Australia, Australia
                [2 ]South Metropolitan Health Service, Murdoch, Western Australia, Australia
                [3 ]Curtin University, Perth, Western Australia, Australia
                [4 ]Edith Cowan University, Joondalup, Western Australia, Australia
                Author notes
                [*]John K. Olynyk, Department of Gastroenterology & Hepatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australia 6150, Australia. Email: john.olynyk@ 123456health.wa.gov.au
                [*]

                Robert J. Tait and John K. Olynyk are equal senior authors

                Author information
                https://orcid.org/0000-0003-0417-3411
                Article
                Publisher ID: 10.1177_21501327211027437
                DOI: 10.1177/21501327211027437
                PMC ID: 8226360
                PubMed ID: 34154445
                SO-VID: 4447c27b-7342-4434-8d35-3f78f60bd1d1
                Copyright © © The Author(s) 2021
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 30 April 2021
                Date revision received : 2 June 2021
                Date accepted : 4 June 2021
                Funding
                Funded by: Western Australian Primary Health Alliance, ;
                Funded by: Curtin University of Technology, FundRef https://doi.org/10.13039/501100001797;
                Categories
                Subject: Original Research
                Custom metadata
                cover-date January-December 2021
                typesetter ts1

                Keywords: hazardous drinking,emergency visits,disease management,access to care,prevention
                Data availability:
                Keywords: hazardous drinking, emergency visits, disease management, access to care, prevention

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