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Background

Alcohol use in a general hospital inpatient population ‘ Hear no evil, see no evil ’ Dr. Kieran O’Loughlin. Background. 1133 admissions in an Irish hospital 30% of men and 8% of women met the DSM IV criteria for alcohol abuse or dependence 1 .

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Background

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  1. Alcohol use in a general hospital inpatient population ‘Hear no evil, see no evil’ Dr. Kieran O’Loughlin

  2. Background • 1133 admissions in an Irish hospital 30% of men and 8% of women met the DSM IV criteria for alcohol abuse or dependence1. • For patients attending accident and emergency the figure may be as high as 40%2.

  3. Background • Screening and brief interventions have been shown to have beneficial effects with respect to long-term outcome in cases of alcohol misuse3. • Hospital-based psychiatric substance use consultations improve engagement in alcohol rehabilitation and treatment outcome4.

  4. In 2006 the Psychiatry of Later Life liaison service in Tallaght Hospital Dublin, received only 8 consultation requests for alcohol misuse (out of a total of 211 requests for psychiatric consultation) representing less than 4% of all referrals.

  5. Objectives • 1. We aimed to determine if poor documentation of alcohol intake is a problem amongst the NCHD (Non-Consultant Hospital Doctor) population in Tallaght hospital.

  6. Objectives • 2. We aimed to assess NCHD’s attitudes towards alcohol misuse to determine if there are specific patient variables which may influence the decision to refer to specialist services.

  7. Objectives • 3. We aimed to assess NCHD’s knowledge of the safe levels of alcohol consumption for both males and females.

  8. Methodology • Part 1 Chart Review • Part 2 Questionnaire

  9. Methodology • Part 2 CASE VIGNETTES • 1. Give no further advice regarding alcohol intake • 2. Advice to cut back on alcohol intake • 3. Advice to abstain from further drinking • 4. Recommend self-referral to alcohol services • 5. Refer to General Practitioner for management • 6. Refer to specialist services

  10. Results • The differences demonstrated between all three subgroups in Table 1 (medical vs. surgical, male vs. female, >65 vs. <65) are statistically significant (0.02< p < 0.05 in all cases). • However the relatively large number patients in the ‘alcohol history but no quantity’ subgroup contributes strongly to the calculation of statistical significance.

  11. Implications – Part 1 • 62% of patients – Quantity of alcohol consumed not documented. • It may represent an attitude amongst NCHDs towards alcohol intake in certain patient populations as defined by age, gender or the nature of presenting complaint. • It may represent a lack of awareness on the part of NCHDs as to the importance of taking an alcohol history. • It may simply represent a lack of knowledge on the part of NCHDs as to how to take an alcohol history.

  12. Results – Part 2 • Our questionnaire dealt with treatment issues. • 2 case vignettes • the presenting complaint was consequent upon alcohol misuse • Case vignette No. 1: 30% • Case vignette No. 5: 78% (chose option of referral to specialist services)

  13. Results – Part 2 • 4 Case vignettes – P/C not consequent upon alcohol misuse. • Case vignette No. 2: 12%. • Case vignette No. 3: 8% • Case vignette No. 5: 4% • Case vignette No. 6: 9%

  14. We must concede that the failure of NCHDs to opt for ‘referral to specialist services’ may also indicate a lack of knowledge as to what services are available to them. To what extent this factor influenced the findings of our study is unclear.

  15. Results • 95% of NCHDs correctly identified the recommended weekly limit of alcohol consumption for both women and men (14 units and 21 units respectively).

  16. Conclusion • Medical education has been shown to lead to improvements in the detection of alcohol misuse by hospital interns5. • This survey clearly identifies a need for further education of NCHDs with regard to the detection of excessive alcohol intake in their patients.

  17. Conclusion • Implement educational programme. • Complete audit cycle next year.

  18. References • 1. Hearne R, Connolly A, Sheehan J. Alcohol abuse: prevalence and detection in a general hospital. J R Soc Med 2002;95:84-87. • 2. Conigrave K, Burns FH, Reznik RB, Saunders JB. Problem drinking in emergency department patients: the scope for early intervention. Med J Aust 1991;154:801-5. • 3. . Babor TF, Higgins-Biddle JC, Dauser D, Burleson JA, Zarkin GA, Bray J. Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Alcohol Alcohol. 2006 Nov-Dec;41(6):624-31. • 4. Hillman A, McCann B, Walker NP. Specialist alcohol liaison services in general hospitals improve engagement in alcohol rehabilitation and treatment outcome. Health Bull (Edinb). 2001 Nov;59(6);420-3. • 5. Gaughwin M, Dodding J, White JM, Ryan P. Changes in alcohol history taking and management of alcohol dependence by interns at the Royal Adelaide Hospital. Med Educ 2000; 34(3):170-4.

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