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Randomized Controlled Trial
. 2005 Mar;12(3):249-56.
doi: 10.1197/j.aem.2004.10.021.

Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department

Gail D'Onofrio  1 , Michael V Pantalon, Linda C Degutis, David A Fiellin, Patrick G O'connor
Affiliations
Randomized Controlled Trial

Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department

Gail D'Onofrio et al. Acad Emerg Med. 2005 Mar.

Abstract

Objectives: 1) To develop and teach a brief intervention (BI) for "hazardous and harmful" (HH) drinkers in the emergency department (ED); 2) to determine whether emergency practitioners (EPs) (faculty, residents, and physician associates) can demonstrate proficiency in the intervention; and 3) to determine whether it is feasible for EPs to perform the BI during routine clinical care.

Methods: The Brief Negotiation Interview (BNI) was developed for a population of HH drinkers. EPs working in an urban, teaching hospital were trained during two-hour skills-based sessions. They were then tested for adherence to and competence with the BNI protocol using standardized patient scenarios and a checklist of critical components of the BNI. Finally, the EPs performed the BNI as part of routine ED clinical care in the context of a randomized controlled trial to test the efficacy of BI on patient outcomes.

Results: The BNI was developed, modified, and finalized in a manual, based on pilot testing. Eleven training sessions with 58 EPs were conducted from March 2002 to August 2003. Ninety-one percent (53/58) of the trained EPs passed the proficiency examination; 96% passed after remediation. Two EPs left prior to remediation. Subsequently, 247 BNIs were performed by 47 EPs. The mean (+/- standard deviation) number of BNIs per EP was 5.28 (+/- 4.91; range 0-28). The mean duration of the BNI was 7.75 minutes (+/- 3.18; range 4-24).

Conclusions: A BNI for HH drinkers can be successfully developed for EPs. EPs can demonstrate proficiency in performing the BNI in routine ED clinical practice.

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Figures

Figure 1
Figure 1
The Spectrum of alcohol use.
Figure 2
Figure 2
National Institute on Alcohol Abuse and Alcoholism (NIAAA) screening questions and guidelines for low-risk drinking. Adapted from the U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Helping Patients with Alcohol Problems: A Health Practitioner’s Guide. Washington, DC: U.S. Government Printing Office, 2004 (NIH publication no. 04-3769).
Figure 3
Figure 3
The readiness to change ruler.
See this image and copyright information in PMC

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