Date Published: January 16, 2013
Publisher: BioMed Central
Author(s): Mary K Murphy, Polly E Bijur, David Rosenbloom, Steven L Bernstein, E John Gallagher.
The study objective was to assess the feasibility of a computerized alcohol-screening interview (CASI) program to identify at-risk alcohol users among adult emergency department (ED) patients. The study aimed to evaluate the feasibility of implementing a computerized screening, brief intervention, and referral to treatment (SBIRT) program within a busy urban ED setting, to report on accurate deployment of alcohol screening results, and to assess comprehension and satisfaction with CASI from both patient and research staff perspectives.
Research assistants (RAs) screened a convenience sample of medically stable ED patients. The RAs brought CASI to patients’ bedsides, and patients entered their own alcohol consumption data. The CASI intervention consisted of an alcohol use screening identification test, a personalized normative feedback profile, NIAAA low-risk drinking educational materials, and treatment referrals (when indicated).
Five hundred seventeen patients were enrolled. The median age of participants was 37 years (range, 21-85 years); 37% were men, 62% were Hispanic, 7% were Caucasian, 30% were African American, and 2% were multiracial. Eighty percent reported regular use of computers at home. Eighty percent of patients approached consented to participate, and 99% of those who started CASI were able to complete it. Two percent of interviews were interrupted for medical tests and procedures, however, no patients required breaks from using CASI for not feeling well. The CASI program accurately provided alcohol risk education to patients 100% of the time. Thirty-two percent of patients in the sample screened positive for at-risk drinking. Sixty percent of patients reported that CASI increased their knowledge of safe drinking limits, 39% reported some likeliness to change their alcohol use, and 28% reported some intention to consult a health care professional about their alcohol use as a result of their screening results. Ninety-three percent reported CASI was easy to use, 93% felt comfortable receiving alcohol education via computer, and 89% liked using CASI. Ninety percent of patients correctly identified their alcohol risk level after participating in CASI. With regard to research staff experience, RAs needed to provide standby assistance to patients during <1% of CASI administrations and needed to troubleshoot computer issues in 4% of interviews. The RAs distributed the correct alcohol risk normative profiles to patients 97% of the time and provided patients with treatment referrals when indicated 81% of the time. The RAs rated patients as “not bothered at all” by using CASI 94% of the time. This study demonstrates that an ED-based computerized alcohol screening program is both acceptable to patients and effective in educating patients about their alcohol risk level. Additionally, this study demonstrates that few logistical problems related to using computers for these interventions were experienced by research staff: in most cases, staff accurately deployed alcohol risk education to patients, and in all cases, the computer provided accurate education to patients. Computer-assisted SBIRT may represent a significant time-saving measure, allowing EDs to reach larger numbers of patients for alcohol intervention without causing undue clinical burden or interruptions to clinical care. Future studies with follow-up are needed to replicate these results and assess drinking reductions post-intervention.
Alcohol misuse is the third leading cause of preventable death in the United States today . The costs to society amount to over 220 billion dollars annually . Most at-risk drinkers never receive needed alcohol treatment services ; however, each year over 130 million people visit an emergency department (ED), creating an opportunity to screen a large number of people who may otherwise have never been asked about their alcohol use or offered alcohol screening, brief intervention, and referral for treatment (SBIRT). Prior research shows that there is a high prevalence of unmet substance abuse treatment need among adult ED patients in general ; estimates show that as many as 46% of ED patients  have recently consumed alcohol, and a significant number of the 31.6 million injury-related ED visits in the US are alcohol-related .
The current study adds to a growing body of literature that finds ED-based computerized alcohol screening programs are both acceptable to patients and effective in educating them about their alcohol risk level. Our feasibility measures revealed that the majority of patients approached for study enrollment were willing to participate (80%), that patients rated the program as easy to use, and that they were not bothered about completing the survey during an unrelated ED visit. The CASI program accurately identified a high number of at-risk drinkers (32%). In addition to these positive findings, research staff reported few study interruptions and logistical barriers to implementing the CASI protocol.
This study demonstrates that computer-delievered brief alcohol screening and intervention programs can be successfully implemented within a busy ED setting, are acceptable to most patients, and can identify a high number of ED patients with at-risk drinking. Additionally, this study demonstrates that few logistical problems related to using computers for these interventions were experienced by patients or research staff. Further studies including a control group and follow-up measures are needed to evaluate the CASI program and determine whether it can reduce alcohol use post-intervention.
The authors declare that they have no competing interests.
MM developed the study question, protocol, trained and supervised all research staff, served as Principal Investigator supervising the conduct of the study, drafted the manuscript and integrated all co-authors contributions. PB contributed to the research design and conducted all statistical analyses in close collaboration with MM. DR facilitated the oversight of the data coordinating center at Boston University. SB contributed to research design and provided guidance on implementing an SBIRT protocol in the ED environment. EJG contributed research design expertise and choice of outcome measures. All authors read and approved the final manuscript.
This study was supported by funding from Join Together (Boston University) and the Bronx Center to Reduce and Eliminate Ethnic and Racial Health Disparities (Bronx CREED). These results were presented in part at the annual meeting of the Society for Academic Emergency Medicine, Boston MA, June 2011.