Crawford Mike J, Patton Robert, Touquet Robin, Drummond Colin, Byford Sarah, Barrett Barbara, Reece Ben, Brown Adrian, Henry John A
Department of Psychological Medicine, Imperial College, London, UK.
Lancet. 2004;364(9442):1334-9. doi: 10.1016/S0140-6736(04)17190-0.
Alcohol misuse is highly prevalent among people attending emergency departments, but the effect of intervention by staff working in these departments is unclear. We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department.
We undertook a single-blind pragmatic randomised controlled trial. Patients received either an information leaflet or an information leaflet plus an appointment with an alcohol health worker. Outcome data were collected by patient interview and examination of hospital records at 6 and 12 months.
599 patients were randomised over a 12-month period. At 6 months, those referred to an alcohol health worker were consuming a mean of 59.7 units of alcohol per week compared with 83.1 units in the control group (t -2.4, p=0.02). At 12 months those referred were drinking 57.2 units per week compared with 70.8 in controls (t -1.7, p=0.09). Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the emergency department over the following 12 months (1.2 compared with 1.7, t -2.0, p=0.046). Differences in quality of life were not found.
Opportunistic identification and referral for alcohol misuse in an emergency department is feasible, associated with lower levels of alcohol consumption over the following 6 months, and reduces reattendance at the department. Short-term reductions in alcohol consumption associated with referral for brief intervention for alcohol misuse benefit patients and reduce demand for accident and emergency department services.
在急诊科就诊的人群中，酒精滥用现象极为普遍，但这些科室工作人员进行干预的效果尚不清楚。我们调查了在急诊科就诊时被发现酒精滥用的患者接受筛查和转诊的效果。
我们进行了一项单盲实用随机对照试验。患者要么收到一份信息传单，要么收到一份信息传单并预约与一名酒精健康工作者见面。在6个月和12个月时，通过患者访谈和检查医院记录收集结果数据。
在12个月期间，599名患者被随机分组。在6个月时，被转诊至酒精健康工作者处的患者平均每周饮酒59.7单位，而对照组为83.1单位（t值为-2.4，p = 0.02）。在12个月时，被转诊者每周饮酒57.2单位，而对照组为70.8单位（t值为-1.7，p = 0.09）。在接下来的12个月里，被转诊至酒精健康工作者处的患者到急诊科就诊的次数平均少0.5次（分别为1.2次和1.7次，t值为-2.0，p = 0.046）。未发现生活质量方面的差异。
在急诊科对酒精滥用进行机会性识别和转诊是可行的，与接下来6个月内较低的酒精消费水平相关，并减少了再次到该科室就诊的次数。与转诊接受酒精滥用简短干预相关的酒精消费短期减少对患者有益，并减少了对急诊科服务的需求。
