Alcohol screening and brief intervention project wins award for promotion of preventative health
A project to investigate the feasibility of delivering routine alcohol screening and brief intervention in a hospital emergency setting was the winner, in the preventative health category, of the Western Australian (WA) Health Excellence Awards 2018. The Health Excellence Awards, presented by the WA Government Department of Health, recognise innovation and excellence in service delivery across eight project categories.
The project was a collaboration between the WA South Metropolitan Health Service (Fiona Stanley Hospital) and the National Drug Research Institute at Curtin University. It was funded by the WA Primary Health Alliance with additional in-kind support provided by the WA South Metropolitan Health Service. The project was unique in its approach as it involved the referral of some patients, identified as moderate or high risk drinkers, to their nominated GP, presenting an opportunity for the issue of alcohol use to be raised and discussed.
The project team developed, implemented and evaluated an alcohol screening and brief intervention (ASBI) program at Fiona Stanley Hospital Emergency Short Stay Unit. A randomised controlled design was used to compare ASBI (usual care) with ASBI plus referral to their general practitioner (Intervention) (ASBI+GP). There was also a third (non-randomised) group who did not have a GP (‘no GP’).
The study recruited people who were aged 18 years or older and who screened as moderate- or high-risk on the three-item alcohol use disorders identification test (AUDIT-C). All participants received a brief intervention, with those screening at ‘high-risk’ also getting a referral to the specialist alcohol and other drug team. Those randomised to the ASBI+GP group had a discharge summary sent to their nominated GP.
453 participants were recruited, with 200 randomised to the intervention group, 189 to usual care, and 64 in the ‘no GP’ group. Forty-three percent were in the ‘high-risk’ category on the AUDIT-C and the overall median weekly alcohol consumption was 20 standard drinks.
Re-interviews with 247 (55%) people were conducted by telephone at three months and, from their AUDIT-C scores, 77 (31%) were low, 111 (45%) moderate and 57 (23%) high-risk drinkers and median alcohol use had declined to 10 drinks/week. More than 70% of the randomised participants had visited a GP by three months; surprisingly, 48% of those in the ‘no GP’ group had also seen one.
At six months, the number of hospital presentations for the six months before and after-recruitment were evaluated using the hospital’s electronic records. These showed that those in the no-GP group had a significantly greater increase in alcohol-related hospital presentations than the ASBI+GP group.
In summary, alcohol use was reduced, with some evidence of reduced alcohol-related hospital presentations. There was extensive use of GP services by this cohort, including by those who did not have a regular GP. This highlights the potential for close collaboration between hospital EDs and GPs in addressing harmful alcohol use by patients.