Challenges and solutions in implementing screening and brief interventions for hazardous alcohol use in accident and emergency departments

There is a wealth of evidence on the detrimental impact of excessive alcohol consumption on

the physical, psychological and social health of the population. There also exists a substantial

evidence base for the efficacy of brief interventions aimed at reducing alcohol consumption

and related harms across a range of healthcare settings. Research conducted in emergency

departments has reinforced the current evidence regarding the potential effectiveness and

cost-effectiveness. However, the majority of this research has been conducted in single

centres and there is little evidence of the wider issues of generalisability and implementation

of brief interventions across emergency departments. The study design is a prospective

pragmatic factorial cluster randomised controlled trial. Emergency Departments (ED) (n = 9)

were randomised to a combination of screening tool (M-SASQ vs. FAST vs. SIPS-PAT) and

an intervention (Minimal intervention-PIL vs. Brief advice-BA vs. Brief lifestyle counseling-

BLC). The primary hypothesis was that BLC delivered by an Alcohol Health Worker (AHW)

was more effective than BA or PIL delivered by ED staff. Secondary hypotheses looked at

whether short screening instruments were more acceptable and as efficient as longer

screening instruments and the cost-effectiveness of SBI in ED. Participants were followed up

at 6 and 12 months. The data analysis has shown a significantly higher positive attitude and

motivation (p < .001) of the 250 A&E staff involved in the trial (SAAPPQ) compared with staff

from primary care and probation settings. This positive attitude also improved after training

(p < .001). However, SBI implementation was difficult and in some settings needed external

support. The main implementation issues, challenges and solutions will be explored. Overall,

a total of 5992 individuals were approached and 3696 were eligible and screened with 1491

screening positive. The initial results indicate a relative high prevalence of alcohol use

disorders in this population (40.3%), which varies considerably across EDs (23.8–71.3%).

Mean age was 40 years and the majority were male (59.2%). In terms of screening tools, the

screen conversion rate was significantly higher for M-SASQ versus FAST and PAT and

significantly higher for M-SASQ versus FAST. Adjusting the analysis using multi-level

modeling to account for potential clustering effects indicated that M-SASQ was significantly

better than PAT at identifying hazardous alcohol users.