Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients

Brianna L Haskins, Rachel Davis-Martin, Beau Abar, Brigitte M Baumann, Tina Harralson, Edwin D Boudreaux, Brianna L Haskins, Rachel Davis-Martin, Beau Abar, Brigitte M Baumann, Tina Harralson, Edwin D Boudreaux

Abstract

Background: Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain.

Objective: The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation.

Methods: Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses.

Results: HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit.

Conclusions: The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA's impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts).

Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://ichgcp.net/clinical-trials-registry/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF).

Keywords: alcohol consumption; emergency medicine; intervention study; referral and consultation.

Conflict of interest statement

Conflicts of Interest: An agreement related to technology used in this study exists between the University of Massachusetts Medical School and Polaris Health Directions. Dr Boudreaux is an employee of the University of Massachusetts Medical School and receives consulting income from Polaris Health Directions. In addition, if the aforementioned technology should be licensed and result in licensing-related income, Dr Boudreaux would receive a share under the University’s allocation policy to inventors. Dr Harralson is an employee of Polaris Health Directions. Dr Abar, Dr Baumann, Dr Davis, and Ms Haskins have no conflicts to disclose.

©Brianna L Haskins, Rachel Davis-Martin, Beau Abar, Brigitte M Baumann, Tina Harralson, Edwin D Boudreaux. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.05.2017.

References

    1. Gonzales K, Roeber J, Kanny D, Tran A, Saiki C, Johnson H, Yeoman K, Safranek T, Creppage K, Lepp A, Miller T, Tarkhashvili N, Lynch KE, Watson JR, Henderson D, Christenson M, Geiger SD, Centers for Disease Control and Prevention (CDC) Alcohol-attributable deaths and years of potential life lost--11 States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2014 Mar 14;63(10):213–6.
    1. Sanjuan PM, Rice SL, Witkiewitz K, Mandler RN, Crandall C, Bogenschutz MP. Alcohol, tobacco, and drug use among emergency department patients. Drug Alcohol Depend. 2014 May 1;138:32–8. doi: 10.1016/j.drugalcdep.2014.01.025.
    1. Centers for Disease Control and Prevention (CDC) Vital signs: binge drinking prevalence, frequency, and intensity among adults - United States, 2010. MMWR Morb Mortal Wkly Rep. 2012 Jan 13;61(1):14–9.
    1. Cherpitel CJ, Ye Y. Drug use and problem drinking associated with primary care and emergency room utilization in the US general population: data from the 2005 national alcohol survey. Drug Alcohol Depend. 2008 Oct 1;97(3):226–30. doi: 10.1016/j.drugalcdep.2008.03.033.
    1. Cunningham RM, Bernstein SL, Walton M, Broderick K, Vaca FE, Woolard R, Bernstein E, Blow F, D'Onofrio G. Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med. 2009 Nov;16(11):1078–88. doi: 10.1111/j.1553-2712.2009.00552.x. doi: 10.1111/j.1553-2712.2009.00552.x.
    1. Centers for Disease Control and Prevention (CDC) CDC. National Hospital Ambulatory Medical Care Survey .
    1. Hankin A, Daugherty M, Bethea A, Haley L. The Emergency Department as a prevention site: a demographic analysis of substance use among ED patients. Drug Alcohol Depend. 2013 Jun 1;130(1-3):230–3. doi: 10.1016/j.drugalcdep.2012.10.027.
    1. Rockett IR, Putnam SL, Jia H, Chang CF, Smith GS. Unmet substance abuse treatment need, health services utilization, and cost: a population-based emergency department study. Ann Emerg Med. 2005 Feb;45(2):118–27. doi: 10.1016/j.annemergmed.2004.08.003.
    1. Rockett IR, Putnam SL, Jia H, Smith GS. Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med. 2003 Jun;41(6):802–13. doi: 10.1067/mem.2003.189.
    1. Lowenstein SR, Koziol-McLain J, Thompson M, Bernstein E, Greenberg K, Gerson LW, Buczynsky P, Blanda M. Behavioral risk factors in emergency department patients: a multisite survey. Acad Emerg Med. 1998 Aug;5(8):781–7.
    1. Keyes KM, Liu XC, Cerda M. The role of race/ethnicity in alcohol-attributable injury in the United States. Epidemiol Rev. 2012;34:89–102. doi: 10.1093/epirev/mxr018.
    1. Williams EC, Gupta S, Rubinsky AD, Jones-Webb R, Bensley KM, Young JP, Hagedorn H, Gifford E, Harris AH. Racial/ethnic differences in the prevalence of clinically recognized alcohol use disorders among patients from the U.S. Veterans Health Administration. Alcohol Clin Exp Res. 2016 Feb;40(2):359–66. doi: 10.1111/acer.12950.
    1. Murphy MK, Bijur PE, Rosenbloom D, Bernstein SL, Gallagher EJ. Feasibility of a computer-assisted alcohol SBIRT program in an urban emergency department: patient and research staff perspectives. Addict Sci Clin Pract. 2013;8:2. doi: 10.1186/1940-0640-8-2.
    1. Substance AbuseMental Health Services Administration. Department of HealthHuman Services SAMHSA. 2013. [2016-10-13]. Innovations in addiction treatment: addiction treatment providers working with integrated primary care services .
    1. Field CA, Baird J, Saitz R, Caetano R, Monti PM. The mixed evidence for brief intervention in emergency departments, trauma care centers, and inpatient hospital settings: what should we do? Alcohol Clin Exp Res. 2010 Dec;34(12):2004–10. doi: 10.1111/j.1530-0277.2010.01297.x.
    1. Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30. doi: 10.1300/J465v28n03_03.
    1. Zarkin GA, Bray JW, Davis KL, Babor TF, Higgins-Biddle JC. The costs of screening and brief intervention for risky alcohol use. J Stud Alcohol. 2003 Nov;64(6):849–57.
    1. Academic ED SBIRT Research Collaborative The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use. Ann Emerg Med. 2007 Dec;50(6):699–710, 710.e1. doi: 10.1016/j.annemergmed.2007.06.486.
    1. U.S. Preventive Services Task Force Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004 Apr 06;140(7):554–6.
    1. Substance Abuse and Mental Health Services Administration. Department of Health and Human Services SAMHSA. 2006. [2016-10-13]. Screening: adds prevention to treatment .
    1. Substance Abuse and Mental Health Services Administration. Department of Health and Human Services . SAMHSA. Rockville, MD: Substance Abuse and Mental Health Services Administration, Department of Health and Human Services; 2012. [2016-10-13]. Coding for SBI reimbursement .
    1. McKnight-Eily LR, Liu Y, Brewer RD, Kanny D, Lu H, Denny CH, Balluz L, Collins J, Centers for Disease Control and Prevention (CDC) Vital signs: communication between health professionals and their patients about alcohol use--44 states and the District of Columbia, 2011. MMWR Morb Mortal Wkly Rep. 2014 Jan 10;63(1):16–22.
    1. Boudreaux ED, Abar B, Haskins B, Bauman B, Grissom G. Health evaluation and referral assistant: a randomized controlled trial to improve smoking cessation among emergency department patients. Addict Sci Clin Pract. 2015 Nov 05;10:24. doi: 10.1186/s13722-015-0045-2.
    1. Cunningham RM, Harrison SR, McKay MP, Mello MJ, Sochor M, Shandro JR, Walton MA, D'Onofrio G. National survey of emergency department alcohol screening and intervention practices. Ann Emerg Med. 2010 Jun;55(6):556–62. doi: 10.1016/j.annemergmed.2010.03.004.
    1. Terrell F, Zatzick DF, Jurkovich GJ, Rivara FP, Donovan DM, Dunn CW, Schermer C, Meredith JW, Gentilello LM. Nationwide survey of alcohol screening and brief intervention practices at US Level I trauma centers. J Am Coll Surg. 2008 Nov;207(5):630–8. doi: 10.1016/j.jamcollsurg.2008.05.021.
    1. Boudreaux ED, Abar B, Baumann BM, Grissom G. A randomized clinical trial of the health evaluation and referral assistant (HERA): research methods. Contemp Clin Trials. 2013 Jul;35(2):87–96. doi: 10.1016/j.cct.2013.04.010.
    1. Etter JF, Perneger TV. Effectiveness of a computer-tailored smoking cessation program: a randomized trial. Arch Intern Med. 2001 Nov 26;161(21):2596–601.
    1. Holtz K, Landis R, Nemes S, Hoffman J. Development of a computerized screening system to identify substance abuse in primary care. J Healthc Qual. 2001;23(3):34–7, 45.
    1. Prochaska JO, Velicer WF, Fava JL, Ruggiero L, Laforge RG, Rossi JS, Johnson SS, Lee PA. Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Prev Med. 2001 Jan;32(1):23–32. doi: 10.1006/pmed.2000.0767.
    1. Revere D, Dunbar PJ. Review of computer-generated outpatient health behavior interventions: clinical encounters “in absentia”. J Am Med Inform Assoc. 2001;8(1):62–79.
    1. Rhodes KV, Lauderdale DS, Stocking CB, Howes DS, Roizen MF, Levinson W. Better health while you wait: a controlled trial of a computer-based intervention for screening and health promotion in the emergency department. Ann Emerg Med. 2001 Mar;37(3):284–91. doi: 10.1067/mem.2001.110818.
    1. Velicer WF, Prochaska JO, Fava JL, Laforge RG, Rossi JS. Interactive versus noninteractive interventions and dose-response relationships for stage-matched smoking cessation programs in a managed care setting. Health Psychol. 1999 Jan;18(1):21–8.
    1. Zeiler CA, Nemes S, Holtz KD, Landis RD, Hoffman J. Responses to a drug and alcohol problem assessment for primary care by ethnicity. Am J Drug Alcohol Abuse. 2002;28(3):513–24.
    1. Boudreaux ED, Bedek KL, Gilles D, Baumann BM, Hollenberg S, Lord SA, Grissom G. The Dynamic Assessment and Referral System for Substance Abuse (DARSSA): development, functionality, and end-user satisfaction. Drug Alcohol Depend. 2009 Jan 1;99(1-3):37–46. doi: 10.1016/j.drugalcdep.2008.06.015.
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993 Jun;88(6):791–804.
    1. Babor TE, Higgins-Biddle J, Dauser D, Higgins P, Burleson JA. Alcohol screening and brief intervention in primary care settings: implementation models and predictors. J Stud Alcohol. 2005 May;66(3):361–8.
    1. . 2014. Planning and implementing screening and brief intervention for risky alcohol use: a step-by-step guide for primary care practices .
    1. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003 Nov;41(11):1284–92. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. William MR, Rollnick S. Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing) New York, NY: The Guilford Press; 2013.
    1. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992 Sep;47(9):1102–14.
    1. Boudreaux ED, Baumann BM, Perry J, Marks D, Francies S, Camargo CA, Ziedonis D. Emergency department initiated treatments for tobacco (EDITT): a pilot study. Ann Behav Med. 2008 Dec;36(3):314–25. doi: 10.1007/s12160-008-9066-3.
    1. Sobell L, Sobell M. National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. [2017-01-17]. Alcohol consumption measures .

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