None listed
Conditions
Brief summary
Background: Both ‘at-risk’ and clinical levels (abuse/dependence) of alcohol use are major causes of morbidity and mortality in Australia and are involved in many hospital presentations. However, few hospitals have instigated routine screening and brief interventions with referral to treatment (SBIRT), an approach that has been widely recommended. Objectives: To investigate the effectiveness of SBI with referral to general practicians (GP) in an Australian setting. Design: Eligible participants will be randomised to either 1) SBI with referral to their GP, or 2) SBI with no GP referral. Outcomes: Primary outcomes relate to measures of feasibility and implementation. The secondary outcomes related to changes in alcohol use and the tertiary outcomes will assess change is the use of hospital services. (Additional time and funds are required to evaluate tertiary outcomes via the WA Data Linkage System.) Participants: All people aged 18 or older entering the Fiona Stanley Hospital emergency short stay unit (ESSU) are eligible for screening (with the AUDIT-C). Those classified as ‘at-risk’ with receive a BI. Those classified as high-risk will receive a BI plus intervention by the hospital alcohol and other drug team. Those who consent will then be randomised. Sample size: Target sample per group 291. (Note we estimate that 146 will not have a GP and thus cannot be randomised). Follow-up: Telephone interviews will be conducted at 1 and 3 months to collect information on change in alcohol consumption and attendance at a GP for alcohol related treatment. At 6 months, data on FSH events (ED and admissions) will be extracted from the hospital databases including Bossnet, EDIS, Webpas. Analysis: The main analyses are descriptive. However, we will use multi-level mixed effect models to assess the interaction term of study group (GP referral vs no referral) by time (6 months pre vs 6 months post) for change in rate of presentations. We also plan two sub-studies. Firstly, validation of self-reports of contact with GPs will be conducted in three groups. From the GP referral arm of the study we will randomly select from those who: 1) report no GP contact (estimate n=10), 2) report GP contact from the moderate risk participants (n=20) and, 3) report GP contact in the high risk group (n=10). At three months we will contact the nominated GP to confirm if the patient has been seen in the interim period and if any information or treatment was provided and obtain GP feedback on the referral process. This is included in the main HREC application but is not an outcome measure for the study. Secondly, feasibility will be tested at Rockingham General Hospital emergency department, where alcohol screening and brief intervention will be introduced without additional research support. A clinical audit will be used to document the proportion of patients screened and receiving appropriate brief intervention. This clinical audit process does not require HREC approva
Interventions
Alcohol screening and brief intervention (where indicated) will be introduced as standard practice in the target ward. Participants will be randomised to receive either discharge information being sent to their General practitioner or treatment as usual.
Patients will be screened with the 3 item alcohol use disorders identification test (AUDIT-C). Men scoring 5-8 and women scoring 4-7 will receive a brief intervention on their alcohol use. Men scoring 9 or more and women scoring 8 or more will a
Alcohol screening and brief intervention (where indicated) will be introduced as standard practice in the target ward. Participants will be randomised to receive either discharge information being sent to their General practitioner or treatment as usual. Patients will be screened with the 3 item alcohol use disorders identification test (AUDIT-C). Men scoring 5-8 and women scoring 4-7 will receive a brief intervention on their alcohol use. Men scoring 9 or more and women scoring 8 or more will also be referred to the hospital alcohol and drug team.. After checking eligibility criteria (see below) patients will be invited to participate in the randomised trial which consists of alcohol related information being sent to their GP or not. The expected duration of recruitment is 6 months. GP referral - this consists of 2 parts. First a summary of the project plus list of local alcohol and other drug services & specialist GP resources. and second a hospital 'discharge' letter outlining the alcohol screening result and the intervention provided in hospital and any additional alcohol related indictors. The GP is invited, "based on this information, and your knowledge of the individual’s medical history, please provide any further intervention that you consider necessary. If you decide that more extensive intervention would be beneficial, we include a flyer on specialist alcohol services in the community". We also plan two sub-studies. Firstly, validation of self-reports of contact with GPs will be conducted in three groups. From the GP referral arm of the study we will randomly select from those who: 1) report no GP contact (estimate n=10), 2) report GP contact from the moderate risk participants (n=20) and, 3) report GP contact in the high risk group (n=10). At three months we will contact the nominated GP to confirm if the patient has been seen in the interim period and if any information or treatment was provided and obtain GP feedback on the referral process. This is included in the main HREC application but is not an outcome measure for the study. Secondly, feasibility will be tested at Rockingham General Hospital emergency department, where alcohol screening and brief intervention will be introduced without additional research support. A clinical audit will be used to document the proportion of patients screened and receiving appropriate brief intervention. This clinical audit process does not require HREC approval.
Sponsors
Fiona Stanley Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients admitted to the Fiona Stanley Hospital emergency short stay unit (FSH ESSU) aged 18 years or older, who are currently resident in Western Australia and able to read and understand spoken English are eligible.
Exclusion criteria
Inability to give informed consent – i.e. unable to understand written or spoken English or due to the severity of the condition (e.g. injury, acute intoxication). Those without a GP will still receive screening and brief intervention and will not be randomised to study groups but will receive the same follow-ups as the study participants (estimate 146 out of 728 screening positive).
Outcome results
None listed