Design

1. Work in progress Started February 2001 Due to complete August 2003 AERC funded project Reducing alcohol misuse in patients attending and Accident & Emergency department There is good evidence to suggest that brief interventions aimed at helping those who misuse alcohol can lead to reduced alcohol consumption (Wilk AJ et al, 1997) and that such interventions are cost effective (Fleming et al, 2000). However this evidence comes mainly from patients treated in primary care and general hospital settings (Chick et al, 1985; Wallace et at, 1988; WHO, 1996). The prevalence of alcohol problems is higher in Accident & Emergency departments than among those in general practice and the majority who attend AED with alcohol related problems are not admitted to hospital (Pirmohamed et al, 2000). Interventions for reducing alcohol misuse may be more successful when they are provided at a time of illness, injury or crisis (Booth and Grosswieler, 1978). The possibility of using an incident that leads to contact with emergency hospital services, together with the high prevalence of alcohol misuse among those attending the AED may make accident and emergency based interventions particularly effective. Objectives Measures To examine the effects at one year of referral for brief intervention by an Alcohol Health Worker (AHW) on levels of alcohol consumption, psychiatric morbidity and quality of life among patients attending an Accident & Emergency department (AED) Alcohol consumption PAT, Form 90 Psychiatric morbidity GHQ-12 Quality of life EQ-5D Economic evaluation based on Design Randomised controlled trial. Data collected on a cohort of hazardous drinkers at six and twelve-months following their initial presentation to the AED. Paddington Alcohol Test • Developed by Smith et al (1996) the Paddington Alcohol test has been designed to identify hazardous drinkers presenting to the AED. • Instead of screening all patients, clinicians are asked to assess those who present with one or more of the conditions found to be associated with hazardous drinking. • PAT has undergone a process of updating and revision Definition of hazardous drinking Patients who consumed eight units once a week or more (male) or six units once a week or more (female), or any patient who declared that their attendance in the AED was related to alcohol regardless of the volume / frequency of consumption. Methods Over a twelve-month period three consecutive teams of thirteen Senior House Officers screened patients presenting to the AED of St Mary’s Hospital (London) using the Paddington Alcohol Test (PAT). All those identified as hazardous drinkers who met the inclusion criteria were asked if they would accept help aimed at assisting them to reduce their alcohol intake. Those randomised to the Treatment condition were given a card detailing the time and place of an appointment to discuss their alcohol consumption with an AHW. Participants were also given a copy of the leaflet ‘Think About Drink’. Those randomised to the Control condition were given the leaflet, but no appointment was made. At baseline demographic details were collected together with information about participants current levels of alcohol consumption. At six-months a telephone interview was conducted to assess alcohol consumption, psychiatric morbidity and suicidal ideation. At twelve-months alcohol consumption, suicidal ideation and quality of life were recorded. At both six and twelve month follow-up participants completed an economic evaluation that examined their employment / benefits situation, use of health and social services and interaction with the criminal justice system. Results 5250 Patients were screened in the AED with 1160 identified as hazardous drinkers. Of these 659 consented to participate and were randomised. Data collection at six-moths has been completed with data collected on 78% of participants. Twelve month data collection is ongoing, and to date we have collected data on 71% of participants. Conclusions This pragmatic study should provide evidence of the worth of a Screening and Brief Intervention programme applied in the AED and offer guidance on the conduct of psychological research within busy hospital settings. References to publications based on this work include: Patton, R., Crawford, M., Touquet, R. (In Press) The effect of health consequences feedback on patients acceptance of advice about alcohol consumption. Emergency Medicine Journal. Patton, R., Touquet, R. (2003) General Practitioner screening for excessive alcohol use. BMJ, 326(7384), 336-337. Patton, R., Touquet, R. (2003) The Paddington Alcohol Test. British Journal of General Practice, 52(474), 59. References to publications based on this work include: Patton, R., Crawford, M., Touquet, R. (In Press) The effect of health consequences feedback on patients acceptance of advice about alcohol consumption. Emergency Medicine Journal. Patton, R., Touquet, R. (2003) General Practitioner screening for excessive alcohol use. BMJ, 326(7384), 336-337. Patton, R., Touquet, R. (2003) The Paddington Alcohol Test. British Journal of General Practice, 52(474), 59.