Yokell Michael A, Camargo Carlos A, Wang N Ewen, Delgado M Kit
Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California.
Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2014 Jul;15(4):438-45. doi: 10.5811/westjem.2013.12.18833.
Emergency department (ED) screening and counseling for alcohol misuse have been shown to reduce at-risk drinking. However, barriers to more widespread adoption of this service remain unclear.
We performed a secondary analysis of a nationwide survey of 277 EDs to determine the proportion of EDs that routinely perform alcohol screening and counseling among patients presenting with alcohol-related complaints and to identify potential institutional barriers and facilitators to routine screening and counseling. The survey was randomly mailed to 350 EDs sampled from the 2007 National Emergency Department Inventory (NEDI), with 80% of ED medical directors responding after receiving the mailing or follow-up fax/email. The survey asked about a variety of preventive services and ED directors' opinions regarding perceived barriers to offering preventive services in their EDs.
Overall, only 27% of all EDs and 22% of Level I/II trauma center EDs reported routinely screening and counseling patients presenting with drinking-related complaints. Rates of routine screening and counseling were similar across geographic areas, crowding status, and urban-rural status. EDs that performed routine screening and counseling often offered other preventive services, such as tobacco cessation (P<0.01) and primary care linkage (P=0.01). EDs with directors who expressed concern about increased financial costs to the ED, inadequate follow-up, and diversion of nurse/physician time all had lower rates of screening and counseling and also more frequently reported lacking the perceived capacity to perform routine counseling and screening. Among EDs that did not routinely perform alcohol screening and counseling, more crowded than non-crowded (P<0.01) and more metro than rural (P<0.01) EDs reported lacking the capacity to perform routine screening and counseling. The capacity to perform routine screening also decreased as ED visit volume increased (P=0.04).
To increase routine alcohol screening and counseling for patients presenting with alcohol-related complaints, ED directors' perceived barriers related to an ED's capacity to perform screening, such as limited financial and staff resources, should be addressed, as should directors' concerns regarding the implementation of preventive health services in EDs. Uniform reimbursement methods should be used to increase ED compensation for performing this important and effective service.
急诊科对酒精滥用进行筛查和咨询已被证明可减少危险饮酒。然而，这项服务更广泛采用的障碍仍不明确。
我们对一项针对277家急诊科的全国性调查进行了二次分析，以确定在出现与酒精相关问题的患者中常规进行酒精筛查和咨询的急诊科比例，并确定常规筛查和咨询的潜在机构障碍及促进因素。该调查随机邮寄给从2007年国家急诊科清单（NEDI）中抽取的350家急诊科，80%的急诊科医疗主任在收到邮件或后续传真/电子邮件后做出了回应。调查询问了各种预防服务以及急诊科主任对在其急诊科提供预防服务的感知障碍的看法。
总体而言，所有急诊科中只有27%以及一级/二级创伤中心急诊科中22%报告常规对出现与饮酒相关问题的患者进行筛查和咨询。常规筛查和咨询率在不同地理区域、拥挤程度和城乡状况中相似。进行常规筛查和咨询的急诊科通常还提供其他预防服务，如戒烟（P<0.01）和与初级保健机构建立联系（P=0.01）。那些主任对急诊科财务成本增加、后续跟进不足以及护士/医生时间被占用表示担忧的急诊科，其筛查和咨询率较低，并且更频繁地报告缺乏进行常规咨询和筛查的感知能力。在不常规进行酒精筛查和咨询的急诊科中，拥挤的急诊科比不拥挤的（P<0.01）以及城市急诊科比农村急诊科（P<0.01）报告缺乏进行常规筛查和咨询的能力。随着急诊科就诊量增加，进行常规筛查的能力也下降（P=0.04）。
为了增加对出现与酒精相关问题患者的常规酒精筛查和咨询，应解决急诊科主任对急诊科进行筛查能力的感知障碍，如有限的财务和人员资源，以及主任对在急诊科实施预防健康服务的担忧。应采用统一的报销方法来增加急诊科因提供这项重要且有效的服务而获得的补偿。
