Hankin Abigail, Haley Leon, Baugher Amy, Colbert Kia, Houry Debra
Emory University, Department of Emergency Medicine, Atlanta, Georgia.
Grady Health System, Atlanta, Georgia.
West J Emerg Med. 2015 Mar;16(2):220-8. doi: 10.5811/westjem.2015.1.24121. Epub 2015 Mar 10.
Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview.
This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test.
A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort.
ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.
每年有800万急诊就诊与酒精使用有关。对急诊患者进行危险酒精和物质使用筛查是筛查、简短干预及转介至治疗项目的一个重要组成部分，已证明其在减少物质使用方面有效。目的是评估急诊患者通过电脑自助服务亭与面对面访谈披露酒精/物质使用情况的接受度和意愿。
这是一项基于调查的横断面研究。符合条件的参与者包括那些前来进行即时分诊、说英语、年龄≥18岁、临床稳定且能够给予同意的患者。患者有机会在急诊候诊室使用自助服务亭，并由研究助理（工作日上午9点至下午5点）进行面对面调查。两项调查均使用经过验证的评估工具来评估药物和酒精使用情况。使用卡方检验和 McNemar 检验计算披露统计数据和偏好。
共筛查了1207名患者：仅面对面筛查229名，通过自助服务亭筛查824名，面对面和自助服务亭都筛查了154名。单模式参与者通过自助服务亭更有可能披露危险饮酒情况（p = 0.003）和高风险药物使用情况（OR = 22.3 [12.3 - 42.2]；p < 0.0001）。通过两种模式都参与过筛查的参与者在自助服务亭更有可能披露高风险药物使用情况（p = 0.003）。当被问及筛查偏好时，73.6%的人表示更喜欢面对面调查，患者认为这种方式在隐私和舒适度方面评分更高。
急诊患者向电脑自助服务亭披露危险酒精和物质使用情况的可能性明显高于向访谈者披露。矛盾的是，尽管向人工筛查者披露的情况较少，但患者表示更喜欢面对面筛查。
