Article Summary
1. Why is this topic important? Alcohol misuse is a major public health
Alcohol abuse is ranked by the World Health Organization as the third leading risk factor for disease and disability in the world (1). It has been estimated that three in 10 adults drink at a level affecting their health. Alcohol is directly associated with damage to multiple parts of the body (2). Data from the Centers for Disease Control and Prevention confirm that alcohol is the third lifestyle-related cause of death nationally, and correlates unhealthy alcohol use with large increases in morbidity 3, 4. An estimated 68.6 million Emergency Department (ED) visits were attributed to alcohol use from 1992 to 2000, and alcohol-related ED visits have increased 18% during this period (5). The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and multiple national bodies recommend Screening and Brief Intervention and Referral Treatment (SBIRT) 6, 7, 8, 9. Although the recommendations have been established, the actual practice in the ED is constrained due to provider time and financial resources, as reported by ED directors (10). Provider time has decreased due to ED crowding in academic centers and urban hospitals while financial resources have dwindled (11). In addition, alcohol use is a sensitive topic for patients, especially to the elderly and those who screen positive for alcohol use. Many physicians and nurses are reluctant to intervene despite being aware of their patients' drinking problems 12, 13.
The computerized health survey has been proven to save time, decrease errors from data entry, and clearly administer and score complex questionnaires. The survey is considered novel by subjects while improving data quality and decreasing costs per survey as opposed to in-person interviewing 14, 15. A Swedish study also provides support that electronic Screening and Brief Intervention is easier to use and does not increase nurses' workload (16).
In our institution, Computerized Alcohol Screening and brief Intervention (CASI) is used in the ED. CASI provides a short, self-administered questionnaire with minimal time requirement from providers (17). The simplicity of CASI enhances health care providers' adherence to alcohol screening protocol in the ED (18). We studied the effectiveness of alcohol screening using CASI by comparing it to alcohol screening performed by nurses at triage during a Medical Screening Examination (MSE) in the ED. We hypothesized that using CASI would improve detection of alcohol drinking in all age and gender groups.
This retrospective study was performed in the ED at an urban, Level I trauma center. Research associates collected data from January 2008 to December 2009. Inclusion criteria were English-speaking or Spanish-speaking ED patients aged 18 years or older. Exclusion criteria were psychiatric and intoxicated patients. Only data from subjects who completed both MSE and CASI were used in the study. The university human subject Institutional Review Board approved this study.
The MSE was a two-part
A total of 7163 patients were found in the CASI/MSE database from January 2008 to December 2009, and 5835 patients were eligible for the study. Of the 1338 excluded patients, 706 patients had performed CASI but did not have an entry in the MSE database as it was incomplete, and 622 patients had completed only CASI, including 269 trauma patients. The patient characteristics are listed in Table 1, with 49% male (n = 2874) and 51% female (n = 2961); primary language was English in 89% of patients
The goal of our study was to compare CASI with current person-to-person interview in a university hospital. Overall, CASI improved screening and detection of at-risk alcohol drinking behavior when compared to traditional person-to-person interview (MSE) in the ED. Our results were consistent with other studies showing that a computerized screening tool has benefit and utility in a health care system with higher compliance from both parties, health care providers and patients 14, 21.
CASI may
CASI is a promising innovative method to increase alcohol screening in the ED. Moreover, CASI seems to encourage patients to divulge alcohol drinking behavior, resulting in a higher percentage of detection for at-risk drinkers in all age groups, genders, and both English- and Spanish-speaking patients. CASI or other equivalent computerized screening programs should be promoted as novel and effective methods for detecting at-risk alcohol use in ED patients. 1. Why is this topic important? Alcohol misuse is a major public health Article Summary
The project described was supported by grantUL1 RR031985 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We would like to thank the members of the Emergency Medicine Research Associate Program, Dr. David Franklin, June Casey, and Christy Carroll for their help with this
A recent systematic review on the personalization of healthcare CAs reported that most CAs personalized their interactions with users, but implementation was not theory-based, and its impact was not fully investigated (Kocaballi et al., 2019). Individuals with mental health disorders, including depression, often find it difficult to express distress for fear of being a burden to their support network or due to stigma, and they may prefer to report sensitive topics using a digital interface (Burkill et al., 2016; Kummervold et al., 2002; Lotfipour et al., 2013). CAs offering anonymous yet personalized (Abd-Alrazaq et al., 2021) conversations may be particularly well placed to support individuals who would be otherwise unwilling to seek help.
Twenty-two papers were excluded due to lack of screening before intervention delivery (Bendtsen et al., 2012; Bingham et al., 2010, 2011; Collins et al., 2014; Donovan et al., 2015; Fazzino et al., 2015; Foster et al., 2015; Hagger et al., 2012; Haug et al., 2013; Hustad et al., 2010; Jouriles et al., 2010; LaBrie et al., 2013; Lovecchio et al., 2010; Murphy et al., 2010; Neighbors et al., 2010; Paschall et al., 2011a,b; Schuckit et al., 2012, 2015; Strohman et al., 2015; Weaver et al., 2014; Wyatt et al., 2013). A further 16 studies did not meet the age range criteria (Bewick et al., 2013, 2010; Enggasser et al., 2015; Sinadinovic et al., 2014; Bendtsen and Bendtsen, 2014; Bendtsen et al., 2015; Doumas et al., 2014; Ekman et al., 2011; Kypri et al., 2010, 2013; Lotfipour et al., 2013; McCambridge et al., 2013; Moreira et al., 2012; Schulz et al., 2012, 2013; Tensil et al., 2013). Four papers were simply commentaries on other studies, or reviews (Cronce et al., 2014; Hustad and Borsari, 2010; Naimi and Cole, 2014; Rodriguez et al., 2015), whilst one study discussed the method of designing a behaviour change intervention (Voogt et al., 2014c), resulting in exclusion from this review.
Computer-assisted SBIRT administered during ED admission may represent a significant time-saving intervention, allowing for reaching larger numbers of patients for alcohol intervention without causing undue clinical burden or interruptions to clinical care (Murphy et al., 2013). A retrospective review found that computer-assisted alcohol screening and brief intervention increased the detection of at-risk alcohol drinkers as compared with medical screening across all ages, gender, and primary language (Lotfipour et al., 2013). Using computers for SBIRT has been in evolution for 2 decades, and recent studies have shown promise for this method (Boudreaux et al., 2013; Heron and Smyth, 2010; Kypri et al., 2008; Linke et al., 2008; Riper et al., 2008).
We evaluated 40 adult healthy subjects with no gastrointestinal symptoms and no systemic diseases who were not taking any regular medications and had a normal CBC and comprehensive metabolic profile. No subjects were daily alcohol drinkers and none were at risk drinkers based on NIAAA criteria (i.e., females more than 3 drinks per day on a regular basis; for men more than four drinks per day) [25]. Subjects had not taken antibiotics for the previous three months, over the counter probiotics or multivitamins for at least the previous two weeks, nor NSAID or high dose aspirin in the previous 4 weeks.
Strengths of the study include the use of a valid screening instrument (Bradley et al., 2007), a pre-tested study procedure (Johnson et al., 2013a), and the large sample size. Although self-reported alcohol consumption via computers has been shown to be reliable (Bonevski et al., 2010; Lotfipour et al., 2012), the main limitation of this study is the reliance on self-report, especially since many participants completed the AUDIT-C in close proximity to other people. Another limitation was the non-collection of alcohol consumption data from 40% of the adult hospital outpatients we invited.