Does Mailed Feedback Decrease Risky Drinking After an Emergency Department Visit?
Intervention in the emergency department (ED) for patients with risky alcohol use can be difficult due to time constraints and other barriers. To test a more viable intervention option, researchers identified 304 risky drinkers* aged ≥14 years in the ED and randomized them to either mailed personalized feedback 7 days after ED discharge or to usual care (no contact after discharge). Participants were young (mean age, 29 years), 74% male, and reported a median of 16 drinks per week and 4 heavy drinking days** per month at baseline. Alcohol use was assessed 6 weeks after ED discharge, and cost-effectiveness of the intervention was calculated. Eighty percent of participants completed follow-up.
- Seventy-one percent of the intervention group recalled receiving the mailed feedback.
- Among participants with alcohol-related ED presentations (23% of the total sample), the intervention group had significantly lower alcohol use at 6 weeks than the usual care group (12 drinks per week versus 24 drinks per week, respectively).
- Among women, the intervention group had significantly fewer heavy drinking days per month than the usual care group (1.6 days versus 4.5 days, respectively).
- The adjusted cost of the intervention was $0.48 AUD (US equivalent, $0.49) per 1 standard drink† per week reduction among participants with an alcohol-related ED presentation. Cost-effectiveness for the entire sample was not calculated.
*Score of ≥8 on the Alcohol Use Disorders Identification Test.
**Defined as ≥5 drinks per day for women and ≥7 drinks per day for men.
†In Australia, 1 standard drink=10 g alcohol.
Comments:
These findings suggest mailed personalized feedback can produce short-term reductions in risky drinking after an ED visit. However, this effect was seen in only a minority of the sample, and the longer term outcomes are unknown. Further research is needed to measure long-term outcomes and to assess how mailed feedback can be integrated with direct intervention in the ED and with primary-care follow-up.
Kevin L. Kraemer, MD, MSc
Reference:
Havard A, Shakeshaft AP, Conigrave KM, et al. Randomized controlled trial of mailed personalized feedback for problem drinkers in the emergency department: the short-term impact. Alcohol Clin Exp Res. October 20, 2011 [E-pub ahead of print]. doi: 0.1111/j.1530-0277.2011.01632.x.