title: Kiosk versus in-person screening for alcohol and drug use in the emergency department: patient preferences and disclosure.
abstract: BACKGROUND
  Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview.
  
  
  METHODS
  This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test.
  
  
  RESULTS
  A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort.
  
  
  CONCLUSIONS
  ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.
authors.affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Abigail
authors.initials: A
authors.lastname: Hankin
authors.affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Leon
authors.initials: L
authors.lastname: Haley
authors.affiliation: Grady Health System, Atlanta, Georgia.
authors.forename: Amy
authors.initials: A
authors.lastname: Baugher
authors.affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Kia
authors.initials: K
authors.lastname: Colbert
authors.affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Debra
authors.initials: D
authors.lastname: Houry
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis*; D001944:Breath Tests / Q000379:methods; D003430:Cross-Sectional Studies; D030881:Disclosure; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference; D019966:Substance-Related Disorders / Q000175:diagnosis*; D014218:Triage / Q000379:methods
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