The effectiveness of alcohol screening and brief intervention in emergency departments: a multicentre pragmatic cluster randomized controlled trial.

Colin Drummond,Paul Cassidy,Paolo Deluca,Christine Godfrey,Nick Heather,Simon Coulton,Steve Parrott,Eileen Kaner,Robert Patton,Katherine Perryman,Robin Touquet,Mike Crawford,Martin Bland,Adenekan Oyefeso,Judy Myles,Tom Phillips,Veronica Dale,Ruth Mcgovern,Dorothy Newbury‐Birch ,Jonathan Paul Shepherd ,Éilish Gilvarry

doi:10.1371/journal.pone.0099463

Abstract

BackgroundAlcohol 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.Methods and FindingsPragmatic 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.ConclusionsSBI 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.Trial RegistrationCurrent Controlled Trials ISRCTN 93681536

Highlights

Alcohol makes a significant contribution to the global burden of disease, injury and economic cost [1]
screening and brief interventions (SBI) is difficult to implement in typical emergency departments (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

Summary

Introduction

Alcohol makes a significant contribution to the global burden of disease, injury and economic cost [1]. Over 20 million people are treated in emergency departments (ED) in England each year of which 35% of attendances are alcohol related, rising to 40% of attendances at weekends and up to 70% at peak times [2,3]. Such presentations offer the opportunity for early identification and intervention to reduce hazardous and harmful drinking [4,5]. 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

Objectives

Methods

Results

Conclusion