The feasibility of alcohol screening and interventions in emergency care: a comparison of primary and specialised health care settings

Abstract

Background: Implementation of alcohol screening and brief intervention in emergency departments is inadequate and the evidence base more mixed than in primary health care (PHC). This comparison study investigates the feasibility of alcohol screening and interventions by nurses in emergency departments, seven based in PHC and two in specialised health care clinics. The aim is to analyse barriers to implementation in these two contexts.Methods: A questionnaire was used among emergency nurses in the Kymenlaakso hospital district in Finland. The response rate was 71% (N = 112; PHC clinics n = 42; specialised clinics n = 38). The statistical differences in responses were analysed using the χ2 test. Open-ended questions were analysed qualitatively.Results: The nurses in specialised clinics treated patients with alcohol-attributable conditions/traumas more often than the nurses in PHC did (p < .001) but were less sure whether it was worthwhile to intervene in the patients’ alcohol use (p < .01). The reasons for reluctance included a lack of time and frustration resulting from discouraging results. The nurses in PHC were more familiar with brief interventions and used AUDIT-C more often than the nurses in specialised clinics (p < .05).Conclusions: The results indicate an intervention paradox in the emergency care setting: compared to nurses in PHC clinics, nurses in specialised health care clinics work more often with intoxicated patients but they are less willing to implement alcohol screening and interventions. The findings highlight the need for institutional-level support in addition to capacity building among nurses.