The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients.
BACKGROUND
One-third of injured patients treated in the emergency department (ED) have an alcohol use disorder (AUD). Few are screened and receive counseling because ED staff have little time for additional tasks. We hypothesized that computer technology can screen and provide an intervention that reduces at-risk drinking (British Medical Association criteria) in injured ED patients.


METHODS
In all, 3,026 subcritically injured patients admitted to an ED were screened for an AUD using a laptop computer that administered the AUD Identification Test (AUDIT) and assessed motivation to reduce drinking. Patients with a positive AUDIT (n = 1,139) were randomized to an intervention (n = 563) or control (n = 576) condition. The computer generated a customized printout based on the patient's own alcohol use pattern, level of motivation, and personal factors, which was provided in the form of feedback and advice.


RESULTS
Most patients (85%) used the computer with minimal assistance. At study entry, a similar proportion in each group met criteria for at-risk drinking (49.6% versus 46.8%, p = 0.355). At 6 months, 21.7% of intervention and 30.4% of control patients met criteria for at-risk drinking (p = 0.008). Intervention patients also had a 35.7% decrease in alcohol intake, compared with a 20.5% decrease in controls (p = 0.006). At 12 months, alcohol intake decreased by 22.8% in the intervention group versus 10.9% in controls (p = 0.023), but the proportion of at-risk drinkers did not significantly differ (37.3% versus 42.6%, p = 0.168).


CONCLUSIONS
The computer-generated intervention was associated with a significant decrease in alcohol use and at-risk drinking. Research is needed to further evaluate and adapt information technology to provide preventive clinical services in the ED.
Neumann
Tim
T
Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Germany.
Neuner
Bruno
B
Weiss-Gerlach
Edith
E
Tønnesen
Hanne
H
Gentilello
Larry M
LM
Wernecke
Klaus-D
KD
Schmidt
Katrin
K
Schröder
Torsten
T
Wauer
Helmar
H
Heinz
Andreas
A
Mann
Karl
K
Müller
Joachim M
JM
Haas
Norbert
N
Kox
Wolfgang J
WJ
Spies
Claudia D
CD
D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D000465:Algorithms; D001604:Berlin / Q000453:epidemiology; D003201:Computers; D003376:Counseling / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy