DiGuiseppi Carolyn, Goss Cynthia, Xu Stanley, Magid David, Graham Allan
University of Colorado School of Medicine, Colorado Injury Control Research Center, Denver, USA.
Alcohol Alcohol. 2006 Jul-Aug;41(4):438-45. doi: 10.1093/alcalc/agl031. Epub 2006 May 5.
We evaluated the effectiveness of telephoning injured patients after discharge, compared with contacting them in the clinic during the acute care visit, for screening for hazardous drinking and eliciting willingness to participate in a lifestyle intervention trial.
We conducted a quasi-randomized controlled trial among acutely injured adult patients in trauma and acute care clinics, assigning telephone and clinic screening strategies systematically by week. During telephone weeks, we mailed study information to patients identified from computerized records, then telephoned them. During clinic weeks, researchers recruited patients awaiting care. We screened for hazardous drinking using the AUDIT-C (Alcohol Use Disorders Identification Test-C). We examined the proportion of all injured adult patients who were screened, the proportion of screened patients with hazardous drinking (AUDIT-C score >or=4), and the proportion willing to participate in a (hypothetical) lifestyle intervention trial. Differences were analysed with non-linear mixed models using generalized estimating equations, controlling for age, sex, and facility. Levers and barriers to screening were explored through structured interviews with research staff.
We enrolled 29% (469/1,609) of all injured adult patients and 76% of injured patients contacted and found to be eligible. Of screened patients, 23.1% screened positive for hazardous drinking. Telephone and clinic contact were equally effective for screening patients (OR = 1.05; 95% CI = 0.59-1.87), identifying hazardous drinking (OR=0.97; 95% CI = 0.54-1.74), and eliciting willingness to participate in an intervention trial (OR=1.49; 95% CI = 0.97-2.30). Clinic site modified results: telephone was more effective than clinic contact for screening urban patients (OR=1.99; 95% CI = 1.36-2.93), but less effective for screening suburban patients (OR = 0.70; 95% CI = 0.69-0.71). Barriers to clinic screening included lack of clinic staff support, time constraints, and difficulty recruiting elderly or acutely distressed patients. Barriers to telephone screening included erroneous contact information and failure to answer the telephone.
Telephone screening is a feasible and efficient method for screening moderately injured adult patients for hazardous drinking, but characteristics of the clinical site (including personnel) influence its effectiveness. Trauma and acute care clinics are likely to be fruitful sites for identification of patients with hazardous drinking, whether for enrollment into brief intervention trials or treatment programmes.
我们评估了出院后给受伤患者打电话的效果，将其与在急性护理就诊期间在诊所联系他们进行比较，以筛查危险饮酒情况并了解他们参与生活方式干预试验的意愿。
我们在创伤和急性护理诊所的急性受伤成年患者中进行了一项准随机对照试验，按周系统地分配电话和诊所筛查策略。在电话筛查周，我们将研究信息邮寄给从计算机记录中识别出的患者，然后给他们打电话。在诊所筛查周，研究人员招募等待护理的患者。我们使用AUDIT-C（酒精使用障碍识别测试-C）筛查危险饮酒情况。我们检查了所有接受筛查的成年受伤患者的比例、筛查出的有危险饮酒情况（AUDIT-C评分≥4）的患者比例以及愿意参与（假设的）生活方式干预试验的患者比例。使用广义估计方程的非线性混合模型分析差异，控制年龄、性别和医疗机构因素。通过对研究人员的结构化访谈探讨筛查的杠杆因素和障碍。
我们纳入了所有成年受伤患者的29%（469/1609）以及76%被联系且被认定符合条件的受伤患者。在接受筛查的患者中，23.1%的患者危险饮酒筛查呈阳性。电话联系和诊所联系在筛查患者（比值比=1.05；95%置信区间=0.59 - 1.87）、识别危险饮酒情况（比值比=0.97；95%置信区间=0.54 - 1.74）以及了解参与干预试验的意愿（比值比=1.49；95%置信区间=0.97 - 2.30）方面同样有效。诊所地点影响结果：电话联系在筛查城市患者方面比诊所联系更有效（比值比=1.99；95%置信区间=1.36 - 2.93），但在筛查郊区患者方面效果较差（比值比=0.70；95%置信区间=0.69 - 0.71）。诊所筛查的障碍包括缺乏诊所工作人员支持、时间限制以及难以招募老年或急性痛苦的患者。电话筛查的障碍包括错误的联系信息和未接听电话。
电话筛查是一种可行且有效的方法，用于对中度受伤的成年患者进行危险饮酒筛查，但临床地点（包括人员）的特征会影响其效果。创伤和急性护理诊所可能是识别有危险饮酒情况患者的有效场所，无论是用于纳入简短干预试验还是治疗项目。
