Alcohol and Alcoholism Advance Access originally published online on October 10, 2007
Alcohol and Alcoholism 2008 43(1):51-52; doi:10.1093/alcalc/agm043
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Teaching hospital staff about hazardous drinking: The effect of a single intervention
Alcohol Department, Hospital Clinic, Barcelona, Spain
* Author to whom correspondence should be addressed at: Unitat d'Alcohologia, C/Villarroel 170; 08036 Barcelona, Spain. Tel. +34 93 227 54 00; Fax. +34 93 227 54 54; E-mail: marc.walther{at}hospvd.ch
Received 27 March 2007; first review notified 8 April 2007; in revised form 13 April 2007; accepted 18 April 2007
 |
ABSTRACT |
|---|
 TOP ABSTRACT IntroductionMethodsResultsDiscussionReferences |
|---|
Aims: To determine if a teaching intervention on hazardous drinking could improve the knowledge, attitudes and clinical behaviour of Health Professionals (HP) in a hospital. Methods: Changes were assessed at baseline and 1 month after the intervention through questionnaires delivered to 38 professionals and interviews with patients (N = 240). Results: Knowledge of professionals improved. No changes were observed through patients' interviews. Conclusions: A single teaching session produces modest but significant changes in the management of alcohol related issues in hospital staff.
|
Introduction |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionReferences |
|---|
Hazardous drinking is known to be quite frequent in the general population. The European Alcohol report of 2004 indicates rates of hazardous alcohol consumption among male and female population in those few countries where studies have been made: 3–23% for men (over 60 g/day) and 1–11% for women (over 40 g/day) (Anderson, 2007
). General literature findings for hospitalized patients vary between 56.4% of problem drinkers identified equally by patients and familiars in trauma units (Donovan et al., 2004) and 25% of the male and 6% of the female patients over 65 years of age (Powell et al., 1994). The efficacy of brief interventions has been well established in outpatients, but remains inconclusive for inpatients, mainly due to positive changes in control groups (Ballesteros et al., 2004; Emmen et al., 2004; Vasilaki et al., 2006).
Low assessment and intervention rates by hospital staff are often explained by not only a lack of training and knowledge, but also by attitudes that consider alcohol consumption a private lifestyle or behaviour impossible to change, (Aalto et al., 2001) and by a variety of barriers and difficulties (lack of time, etc). A previous study of our group revealed that patients are usually referred for alcoholism treatment at a very late stage of their addiction, resulting in a mortality of 30% in 4 years (Monras et al., 2005).
Training Health Professionals (HP) to identify hazardous drinkers could result in earlier detection. In this work, we study the impact of an alcohol training session on the knowledge, attitudes and clinical behaviour of Hospital HP.
|
Methods |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionReferences |
|---|
The study was conducted in four departments: Cardiology, Internal Medicine, pneumology and Psychiatry. The training package consisted of an introduction to the concept of hazardous drinking and its clinical relevance. We then explained what was meant by brief intervention and handed out some printed material for professionals and patients.
Baseline data were obtained of at least 25 patients per ward on the day of their discharge, and their medical records were audited for alcohol consumption. Exclusion criteria was cognitive deterioration. Patients' questionnaires included AUDIT-C (Gual et al., 2002), and questions on whether they had been asked about their alcohol consumption, had received any advice, or were considering changing their drinking behaviour. HP questionnaires included Audit-C, and data on knowledge, attitudes and clinical behaviour concerning the assessment of alcohol consumption. Assessment was conducted right before the training session and 1 month later.
Hazardous drinking was defined as an AUDIT-C score of 5 or more for men and 4 or more for women respectively (Gual et al., 2002).
|
Results |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionReferences |
|---|
Thirty eight HP attended the training session (57.8% of staff) of who 34 were also available at 1 month follow up. Of these, 36.8% were physicians, 47.3% nurses, and 15.8% other health professionals. As it can be seen in Table 1, knowledge of tools to conduct early identification of hazardous drinking (standard drink units, questionnaires) improved after training. Alcohol was seen as an important health determinant, but most of the HP felt they lacked training to conduct interventions successfully. Differences were lower after training but did not reach statistical significance. Self-rated behaviour of HP remained stable but records in patients' files on substance abuse and alcohol consumption improved significantly (Table 1).
|
One hundred and eighteen patients were interviewed before the interventions and 122 1 month later. Three patients had to be excluded for cognitive deterioration, one refused. No significant differences were found in samples concerning age (64.05 SD 18.82), gender (58.8% women), educational level and hazardous drinking rates (18.6% pre and 18.0% post). The rate of patients who had not been asked about their alcohol consumption remained stable (43.6 vs 41.8%) but hazardous drinkers were asked significantly more often (59.1.0 vs 39.0%; chi square P0.012).
|
Discussion |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionReferences |
|---|
The relatively small number of patients and professionals is an important limitation of this study. Furthermore, the wards were not randomly selected and data cannot be viewed as representative of the whole Hospital and the prevalence of drinking laid within the expected range in males, but was higher than expected in females.
Training was delivered to less than two-thirds of HP, and even though it was for just 1 h, it improved knowledge and increased the tendency to register alcohol consumption in patients' files. The attitude towards intervention changed positively (Table 1). Most of HP considered alcohol a very important topic and asked for more training. Since data show a non-significant tendency to improvement in skills after 1 h training, it seems reasonable to develop a continuous medical education strategy.
Key-message
Even one-time interventions can stimulate some modest but perceptible changes in HP attitudes and behaviours regarding hazardous drinking. More continuous strategies need to be developed.
|
FOOTNOTES |
|---|
The originally published version of this paper was incorrect. The author's name was spellt incorrectly, it should read Marc Walther.
|
References |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionReferences |
|---|
Aalto M., Pekuri P., Seppa K. Primary health care nurses' and physicians attitude, knowledge and beliefs regarding brief intervention for heavy drinkers. Addiction (2001) 96(2):305–311.[CrossRef][Web of Science][Medline]
Anderson P. (2007) Report Alcohol in Europe: available at: http://ec.europa.eu/health-eu/doc/alcoholineu_chap4_en.pdf (accessed 10 Feb).
Ballesteros J., Duffy JC., Querejeta I., et al. Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. Alcoholism-Clinical and Experimental Research (2004) 28(4):606–618.
Donovan D. M., Dunn CW., Rivara FP., et al. Comparison of trauma center patient self-reports and proxy reports on the Alcohol Use Identification Test (AUDIT). Journal of Trauma (2004) 56(4):873–882.
Emmen M. J., Schippers GM., Bleijenberg G., et al. Effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting. British Medical Journal (2004) 7:318–328.
Gual A., Segura L., Contel M., et al. Audit-3 and Audit-4: effectiveness of two short forms of the alcohol use disorders identification test. Alcohol and Alcoholism (2002) 37:591–596.
Monras M., Mondon S., Ortega L., et al. Alcoholism in the general hospital: 4 years mortality and hospitalization. Medicina Clinica (Barcelona) (2005) 125:441–447.
Powell J. E., Mclnness E. Alcohol use among older hospital patients: findings from an Australian study. Drug and Alcohol Review (1994) 13(1):5–12.[CrossRef][Medline]
Vasilaki E. I., Hosier SG., WM Cox. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol and Alcoholism (2006) 41(3):328–335.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||