A critical need exists to refine and test brief interventions (BI) for Emergency Department(ED) populations with hazardous and harmful (HH) drinking that can be translated into real-world settings; and to enhance the effects of these BIs so they can be maintained over time. The ED is an ideal setting for BIs, as many ED patients who exceed low-risk recommendations do not have contact with either alcohol treatment specialists or visit primary care medical practitioners. This includes a large segment of young adults ages 18-30 whose only contact with the health care system is often an ED visit. The purpose of this study is to evaluate the effectiveness of an enhanced Emergency Practitioner (EP) performed BI, namely, the Enhanced Brief Negotiation Interview (E-BNI). This includes a basic BNI performed in the ED with referral to a primary care provider, followed by a telephone booster intervention performed by trained nurses 1-month post ED visit. The E-BNI will be compared to the basic BNI (without booster), and standard care with assessments (SC-A) and without (SC-NA). In a randomized, controlled clinical trial 990 HH drinkers will be randomly assigned to one of the 4 conditions. Primary hypotheses to be tested include: The E-BNI will be superior to the BNI and SC conditions, and BNI will be superior to the SC conditions in (1) reducing self-reported 7-day alcohol consumption and binge drinking episodes in the past 28 days; and 2) increasing utilization of primary care and alcohol related services. Secondary hypotheses include: The E-BNI will be superior to the BNI and SC conditions, and the BNI will be superior to the SC conditions in reducing alcohol-related negative consequences and; 2) decreasing repeat ED visits and days of hospitalization; and 3) patients receiving SCA condition will report greater reductions in alcohol consumption than those receiving the SC-NA condition. We will conduct cost benefit analysis of the interventions. Follow-up assessments, at 6 and 12-months, will be obtained via interactive voice response (IVR). Unique features of the current project as compared to earlier studies include: 1) use of existing, trained EP/study staff; 2 ) a credible control condition with/without assessments to test their impact on outcomes; 3) enrollment of a heterogeneous ED population and 4) use of IVR to promote accurate, non biased subject self-reporting; and 5) an analysis of relative economic costs and benefits of the tested interventions.
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| D'Onofrio, Gail; Fiellin, David A; Pantalon, Michael V et al. (2012) A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med 60:181-92 |
| Broderick, Kerry B; Ranney, Megan L; Vaca, Federico E et al. (2009) Study designs and evaluation models for emergency department public health research. Acad Emerg Med 16:1124-31 |
