Emergency room intervention can cut alcohol intake
MedWire News: Brief interventions delivered to patients in the emergency department (ED) can help reduce dangerous hazardous and harmful drinking behavior, a randomized trial indicates.
The findings, if confirmed in further trials, support the incorporation of these interventions into routine ED care, say Gail D'Onofrio (Yale University School of Medicine, New Haven, Connecticut, USA) and co-authors in the Annals of Emergency Medicine.
The US Preventive Services Task Force currently recommends screening and brief intervention for at-risk drinkers, but evidence of this approach delivered in the ED is inconclusive.
D'Onofrio and co-authors therefore designed a randomized trial to compare three ED-based strategies: a brief intervention (the Brief Negotiation Interview) performed by an emergency practitioner; the same intervention plus a nurse-delivered booster call at 1 month; and standard care (no assessment).
The Brief Negotiation Interview, which took a median of 7 minutes to deliver, had four components: raising the subject of alcohol; providing feedback by reviewing the patient's screening data and connecting alcohol with the ED visit; enhancing motivation to reduce drinking; and negotiating a drinking goal.
The booster call lasted 10 minutes on average and featured assessment of drinking levels, reinforcement of methods, and discussion of relapse prevention.
The trial included 889 ED patients who were considered to exhibit "hazardous or harmful drinking." None was alcohol dependent or currently receiving treatment for alcohol use or were actively suicidal or psychotic.
The study had two primary outcomes: patient-reported alcohol consumption in the previous 7 days and the number of binge-drinking episodes in the past 28 days, each measured at 12 months.
Alcohol consumption declined in all three groups between baseline and 12 months, report the researchers. The decline was statistically significant in the two intervention groups, but not in the control group, supporting a significant treatment effect.
The same pattern was seen for binge-drinking episodes, which declined over time in all three groups but to a greater extent in the two treatment groups, again supporting a significant effect of the intervention.
For both outcomes, there was no difference between the intervention alone and the intervention plus booster call.
Secondary analyses revealed that both interventions were associated with a significant reduction in impaired driving practices (ie, driving while intoxicated). Meanwhile, all three groups saw reductions in the number of motor vehicle crashes while intoxicated and in the number of days missed off work.
D'Onofrio and co-authors say their data "provide support for the value of brief intervention in the ED" but add that "a "single booster, requiring additional resources, did not improve outcomes."
They also remark that the benefits of the intervention were most pronounced in people older than 26 years, whereas younger patients typically "rebounded" towards their baseline values by 12 months.
"In conclusion, brief interventions performed by emergency practitioners reduce alcohol consumption and episodes of impaired driving," they write. "These findings have implications for practice and health policy."
By Joanna Lyford