Background : A variety of policy groups have recommended that screening and brief interventions (BIs) for alcohol disorders be widely implemented in health care settings. This study was conducted to determine the current status of screening and intervention programs in trauma centers and to evaluate specific barriers to implementation of screening and BIs. The hypotheses tested were that surgeons who support screening and brief interventions would be less likely to endorse the purported barriers to screening and intervention and would have a better understanding of the concept of brief interventions.
Methods : A postal survey of 711 members of the American Association for the Surgery of Trauma and the Western Trauma Association was performed to assess current screening and treatment practices, along with barriers to screening and intervention. Two logistic regression models were constructed to determine which factors result in support for screening and which factors predict support of BIs to help determine potentially modifiable issues to facilitate implementation.
Results : Three hundred eighty-three surgeons responded, 315 of whom are currently practicing trauma. The majority of surgeons (267 [83%]) agreed that a trauma center is an appropriate setting for addressing harmful alcohol consumption. Over two thirds frequently check a blood alcohol concentration, with one third of the group reporting that they always do. The use of formal screening questionnaires was much less frequent (25%). Nearly one half (49%) understood the concept of BIs. However, the majority report that less than one half of patients with a suspected alcohol problem at their center have their alcohol problem addressed while they are hospitalized. Several barriers to screening and BIs were identified. Although only 2% thought screening and counseling would significantly increase health care costs, 7% thought screening was too time consuming and 13.6% thought it would compromise patient confidentiality. Screening was perceived to threaten reimbursement by 27%. Over half (55%) stated their facility is currently performing screening. One third (36%) stated their facility is currently performing BIs. Logistic regression revealed that surgeons who support screening were those who thought patients with alcohol problems should be referred for professional alcohol treatment (odds ratio [OR], 6.5; 95% confidence interval [CI], 2.3-18.2) and that a trauma center is an appropriate setting for addressing alcohol disorders (OR, 6.2; 95% CI, 2.7-14.2). In the model of support for BIs, understanding the concept of BIs (OR, 5.7; 95% CI, 3.1-10.5) and lack of the belief that screening and intervention would increase cost too much (OR, 0.14; 95% CI, 0.02-0.96) were the most potent predictors of support for BIs.
Conclusion : Trauma surgeons are screening for alcohol disorders more frequently than they were 5 years ago. Barriers to screening are not as prevalent as previously reported. Support for implementing screening and intervention programs depends on whether surgeons believe trauma centers are appropriate sites for addressing alcohol disorders, whether surgeons believe patients with alcohol problems should be referred for professional treatment, whether surgeons understand the concept of brief interventions, and whether they believe the cost constraints are not prohibitive. Widespread education in the effectiveness and methods of BIs would facilitate implementation of alcohol screening and intervention programs to help reduce recurrent alcohol-related injury.
More than 30 randomized trials have demonstrated the efficacy of brief counseling sessions for nondependent problem drinkers. 1-4 There is consensus among many professional medical groups that clinicians should routinely discuss patterns of alcohol use with all patients. 5,6 A 1990 Institute of Medicine panel recommended screening adults in medical settings for problem drinking and offering brief counseling to nondependent problem drinkers. 7 The United States Preventive Services Task Force 8 has also stated that patients with evidence of alcohol abuse or hazardous drinking should be offered brief advice and counseling.
These recommendations are applicable to trauma centers, given that more than 50% of trauma is alcohol related and that there is increasing evidence that brief interventions (BIs) for alcohol disorders are effective at reducing alcohol consumption, 1-3 recurrent injury, 9 and driving under the influence of alcohol. 10,11 This study was conducted to determine the current status of screening and intervention programs in trauma centers and to evaluate specific barriers to implementation of screening and brief interventions. The hypotheses tested were that surgeons who support screening and brief interventions would be less likely to endorse the purported barriers to screening and intervention and would have a better understanding of the concept of brief interventions.