Written Advice for Emergency Care Patients: Does It Work?

Emergency care clinicians need pragmatic and effective methods to screen for and address risky drinking. In this study, Swedish researchers assessed whether emergency care patients may benefit from simple written advice about safer drinking. During the first half of the study, they screened 771 emergency care patients for risky drinking*; for the remaining half, they screened another 563 and provided written advice (without counseling). Researchers assessed alcohol measures at baseline and 6 months later (approximately 50% follow-up rate).

• Approximately 23% of patients drank risky amounts at baseline.
• The proportion of risky drinkers with heavy drinking episodes** decreased significantly from baseline to follow-up in both groups (from 92% to 68% of those receiving written advice; from 94% to 59% of those receiving screening only).
• Among patients receiving written advice, the proportion of risky drinkers ready to change their drinking significantly increased (from 8% at baseline to 23% at follow-up).

Comments:

This study showed that written advice does little to reduce risky drinking. The authors’ contention that screening alone may have reduced the likelihood of heavy drinking episodes is suspect for several reasons (e.g., nonrandomized study design, limited follow-up). Further, fewer subjects may have had heavy drinking episodes because of their injury, not because they received alcohol screening. The search for an efficient alcohol intervention in the busy emergency setting still requires attention.

Jeffrey H. Samet, MD, MA, MPH

Reference:

Nordqvist C, Wilhelm E, Lindqvist K, et al. Can screening and simple written advice reduce excessive alcohol consumption among emergency care patients? Alcohol Alcohol. 2005;40(5):401–408.