title: The effectiveness of alcohol screening and brief intervention in emergency departments: a multicentre pragmatic cluster randomized controlled trial.
abstract: BACKGROUND
  Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial.
  
  
  RESULTS
  Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings.
  
  
  CONCLUSIONS
  SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN 93681536.
authors: Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors: Colin
authors: C
authors: Drummond
authors: Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors: Paolo
authors: P
authors: Deluca
authors: Centre for Health Service Studies, University of Kent, Canterbury, United Kingdom.
authors: Simon
authors: S
authors: Coulton
authors: Department of Health Sciences, University of York, York, United Kingdom.
authors: Martin
authors: M
authors: Bland
authors: Teams Family Practice, Gateshead, United Kingdom.
authors: Paul
authors: P
authors: Cassidy
authors: Department of Psychological Medicine, Imperial College, London, United Kingdom.
authors: Mike
authors: M
authors: Crawford
authors: Department of Health Sciences, University of York, York, United Kingdom.
authors: Veronica
authors: V
authors: Dale
authors: Institute of Health and Society, Newcastle University, Newcastle, United Kingdom; Northern Regional Drug and Alcohol Services, Newcastle, United Kingdom.
authors: Eilish
authors: E
authors: Gilvarry
authors: Department of Health Sciences, University of York, York, United Kingdom.
authors: Christine
authors: C
authors: Godfrey
authors: Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom.
authors: Nick
authors: N
authors: Heather
authors: Institute of Health and Society, Newcastle University, Newcastle, United Kingdom.
authors: Ruth
authors: R
authors: McGovern
authors: Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors: Judy
authors: J
authors: Myles
authors: Institute of Health and Society, Newcastle University, Newcastle, United Kingdom.
authors: Dorothy
authors: D
authors: Newbury-Birch
authors: Division of Population Health Sciences and Education, St George's, University of London, London, United Kingdom; Jeesal Cawston Park Hospital, Norfolk, United Kingdom.
authors: Adenekan
authors: A
authors: Oyefeso
authors: Department of Health Sciences, University of York, York, United Kingdom.
authors: Steve
authors: S
authors: Parrott
authors: Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors: Robert
authors: R
authors: Patton
authors: Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors: Katherine
authors: K
authors: Perryman
authors: Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom; Humber NHS Foundation Trust, Willerby, United Kingdom.
authors: Tom
authors: T
authors: Phillips
authors: Violence Research Group, Cardiff University, Cardiff, United Kingdom.
authors: Jonathan
authors: J
authors: Shepherd
authors: Emergency Department, Kingston Hospital, Kingston upon Thames, London, United Kingdom.
authors: Robin
authors: R
authors: Touquet
authors: Institute of Health and Society, Newcastle University, Newcastle, United Kingdom.
authors: Eileen
authors: E
authors: Kaner
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D003419:Crisis Intervention / Q000379:methods; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D016896:Treatment Outcome