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Alcohol-Related Emergency Department Visits in the United States

Alcohol-Related Emergency Department Visits in the United States. Center to Prevent Alcohol Problems Boston University School of Public Health Ralph Hingson, ScD Michael Winter, MPH American Public Health Association Annual Meeting Washington, DC November 10, 2004.

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Alcohol-Related Emergency Department Visits in the United States

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  1. Alcohol-Related Emergency Department Visits in the United States Center to Prevent Alcohol Problems Boston University School of Public Health Ralph Hingson, ScD Michael Winter, MPH American Public Health Association Annual Meeting Washington, DC November 10, 2004

  2. GentilelloBrief Motivational Alcohol Intervention in a Trauma Center; Annals of Surgery, 1999 • 46% of injured trauma center patients age 18 and older screened positive for alcohol problems. • Half (N=336) randomly allocated to receive 30 minute brief intervention to reduce risky drinking and offered links to alcohol treatment

  3. GentilelloBrief Motivational Alcohol Intervention in a Trauma Center; Annals of Surgery, 1999 • Reduced alcohol consumption by an average 21 drinks per week at 1 year follow up • 47% reduction in new injuries requiring treatment in ED • 48% reduction in hospital admissions for injury over 3 years • 23% fewer drunk driving arrests

  4. MontiBrief Intervention For Harm Reduction with Alcohol Positive Older Adolescents in a Hospital Emergency Department, J. Consulting and Clinical Psychology • 94 ED patients, mean age 18.4, injured after drinking • Half randomly allocated to a 35-40 minute motivational intervention to reduce drinking and related risky behaviors such as DWI • 89% followed at 6 months, no difference between groups: • Follow up rate • Age • gender

  5. Monti et al., 1999Results at 6 months Comparable drinking declines in both groups

  6. Longabaugh (2001) 539 Injured Emergency Department Patients R Brief Intervention (BI) Standard Care (SC) Brief Intervention and Booster (BIB) J. Studies on Alcohol. 62: 806-816

  7. Longabaugh 2001Brief Intervention 40-60 minutes (based on Motivational Enhancement Intervention in Project MATCH) • Patients queried about the connection between drinking and their injury • Patients drinking compared to National Sample • Financial cost of drinkers and negative consequences assessed • Work plan to reduce drinking developed (if goal of patient)

  8. Longabaugh 2001 Booster Session • 7 days after Brief Intervention • Discussed post discharge drinking and experiences

  9. Results: Longabaugh 2001 • Standard care (SC) 6% decline in alcohol related injuries • BIB 36% decline in alcohol related injuries than standard care • No differences BI and SC • Negative drinking consequences • Number of heavy drinking days • Injuries • Number of heavy drinking days similar in all 3 groups at follow up

  10. Recent studies showing positive benefits of screening and brief intervention • Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, Reece B, Brown A, Henry JA. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet. 2004 Oct 9;364(9442):1334-9. • Spirito A, Monti PM, Barnett NP, Colby SM, Sindelar H, Rohsenow DJ, Lewander W, Myers M. A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. J Pediatr. 2004 Sep;145(3):396-402. • Dill PL, Wells-Parker E, Soderstrom CA. The emergency care setting for screening and intervention for alcohol use problems among injured and high-risk drivers: a review. Traffic Inj. Prev. 2004 Sep;5(3):278-91. Review. • Whitlock EP, Polen MR, Green CA, Orleans T, Klein J; U.S. Preventive Services Task Force. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004 Apr 6;140(7):557- 68. Review

  11. Purpose • To determine how many emergency department visits annually in the U.S. are: • Alcohol Related • Alcohol related injuries • To determine • What proportion of persons admitted to emergency departments for alcohol related problems are referred to additional alcohol treatment • Whether likelihood of referral varies by injury severity

  12. Methods • National Hospital Ambulatory Care Survey January 1-December 31, 2001 • Hospitals in the 2000 SMC Hospital Data Base (50 added in 2001 new or changed eligibility) • 4 stage Probability Sampling. Primary Sampling Units (PSUs) 479 Hospitals within PSUs. 395 EDs within Hospitals and/or clinics within obligated departments. • 90% ED participation • 85% Visit response rate N=34, 546 completed patient record forms

  13. Results • 2001 107.5 million ED visits • 2.5 million alcohol related ED visits (2%) • 39.4 million injury/poisoning visits 5% alcohol related N= 2 million

  14. Results • 94,589,648 first time visits • 2,162,807 alcohol related (2%) • 35,358,989 Injury related 5% alcohol related N= 1,860,814

  15. Results: 1st Time Admissions • 86% treated and discharged 2% alcohol related N= 1,712,598 • <1% held for 23 hours observation (544,541) 3% alcohol related N= 18,968 • 11% admitted to hospital (10,848,702) 3% alcohol related N= 362,280 • 1% admitted to ICU/CCU (973,733) 6% alcohol related N= 53,984 • 0.2% died (228,689) 6% alcohol related N= 14,802

  16. Results • Among ED alcohol related patients not observed or admitted to the Hospital ICU/CCU, 14.9% were referred to additional alcohol treatment • Among ED alcohol related injury patients observed, only 3% were referred to alcohol or drug treatment • Among ED alcohol related injury visits hospitalized, only 2% (N=6,297) were referred for additional alcohol treatment • Among ED alcohol related injury visits admitted to ICU/CCU none were referred to additional alcohol treatment

  17. Conclusion • The more serious the injury the greater the percentage that were alcohol related • The less serious the alcohol-related injury, the greater the likelihood the patient would be referred for alcohol treatment

  18. Discussion McDonald, Wang, Camarge. Archives of Internal Medicine. 1643: 531-537, 2004 • Examined 2000 National Hospital Ambulatory Care Survey • Assigned Alcohol Attributable Fractions to 37 diagnoses at admission (AAF) • AAF was calculated based on extensive review of clinical case series, injury surveillance studies available epidemiologic studies • AAF represents the proportion disease cases, deaths or injuries causally linked to alcohol misuse • Each of the 37 diagnosis multiplied by the number of ED visits for each diagnosis

  19. 3 Groups of AAF’s • 100% attributable to alcohol by alcohol dependence alcoholic cirrhosis • AAF <1 disease e.g. oral cancer 50% • AAF <1 injuries e.g. motor vehicle injuries 42%

  20. Key Findings • Instead of 2.2 million alcohol related ED visits they estimated there are 8.4 million alcohol related visits • Only 20% of patients with 100% alcohol attributable conditions were admitted to hospitals meaning many are discharged without alcohol treatment

  21. Discussion • Emergency Departments or Trauma Centers should screen all patients for alcohol • Alcohol related ED admissions offer a teachable moment for successful brief intervention • 35 states have laws allowing insurance companies to deny medical reimbursement for treating patients injured under the influence • These laws should be repealed and the effects on the proportions of patients screened and offered brief intervention for alcohol should be monitored

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