Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial.
BACKGROUND
Alcohol misuse is highly prevalent among people attending emergency departments, but the effect of intervention by staff working in these departments is unclear. We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department.


METHODS
We undertook a single-blind pragmatic randomised controlled trial. Patients received either an information leaflet or an information leaflet plus an appointment with an alcohol health worker. Outcome data were collected by patient interview and examination of hospital records at 6 and 12 months.


RESULTS
599 patients were randomised over a 12-month period. At 6 months, those referred to an alcohol health worker were consuming a mean of 59.7 units of alcohol per week compared with 83.1 units in the control group (t -2.4, p=0.02). At 12 months those referred were drinking 57.2 units per week compared with 70.8 in controls (t -1.7, p=0.09). Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the emergency department over the following 12 months (1.2 compared with 1.7, t -2.0, p=0.046). Differences in quality of life were not found.


CONCLUSIONS
Opportunistic identification and referral for alcohol misuse in an emergency department is feasible, associated with lower levels of alcohol consumption over the following 6 months, and reduces reattendance at the department. Short-term reductions in alcohol consumption associated with referral for brief intervention for alcohol misuse benefit patients and reduce demand for accident and emergency department services.
Department of Psychological Medicine, Imperial College, London, UK. m.crawford@imperial.ac.uk
Mike J
MJ
Crawford
Robert
R
Patton
Robin
R
Touquet
Colin
C
Drummond
Sarah
S
Byford
Barbara
B
Barrett
Ben
B
Reece
Adrian
A
Brown
John A
JA
Henry
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000517:prevention & control*; D000437:Alcoholism / Q000175:diagnosis / Q000534:rehabilitation*; D001071:Appointments and Schedules; D003376:Counseling; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010349:Patient Compliance; D010353:Patient Education as Topic; D012017:Referral and Consultation; D016037:Single-Blind Method; D011795:Surveys and Questionnaires