title: Success of referral for alcohol dependent patients from a general hospital: predictive value of patient and process characteristics.
abstract: To assess the effectiveness of a multidisciplinary evaluation and referral process in a prospective cohort of general hospital patients with alcohol dependence. Alcohol-dependent patients were identified in the wards of the general hospital and its primary care center. They were evaluated and then referred to treatment by a multidisciplinary team; those patients who accepted to participate in this cohort study were consecutively included and followed for 6 months. Not included patients were lost for follow-up, whereas all included patients were assessed at time of inclusion, 2 and 6 months later by a research psychologist in order to collect standardized baseline patients' characteristics, process salient features and patients outcomes (defined as treatment adherence and abstinence). Multidisciplinary evaluation and therapeutic referral was feasible and effective, with a success rate of 43%for treatment adherence and 28%for abstinence at 6 months. Among patients' characteristics, predictors of success were an age over 45, not living alone, being employed and being motivated to treatment (RAATE-A score < 18), whereas successful process characteristics included detoxification of the patient at time of referral and a full multidisciplinary referral meeting. This multidisciplinary model of evaluation and referral of alcohol dependent patients of a general hospital had a satisfactory level of effectiveness. Predictors of success and failure allow to identify subsets of patients for whom new strategies of motivation and treatment referral should be designed.
authors.affiliation: Division of Substance Abuse, University Hospital, BH 06-429, Lausanne, Switzerland.
authors.forename: Stephane
authors.initials: S
authors.lastname: Rochat
authors.forename: Vincent
authors.initials: V
authors.lastname: Wietlisbach
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Ulrika
authors.initials: U
authors.lastname: Landry
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome