Help for Drinking Unpopular During Minor Injury Treatment

Nancy A. Melville

December 23, 2011

December 23, 2011 — Patients presenting at minor injuries units (MIUs) in the United Kingdom may often fit the profile of "hazardous"" drinkers, making such settings ideal for interventions and advice to support problem drinking, according to a pilot study published online December 21 in Emergency Medicine Journal.

MIUs, somewhat like urgent care centers in the United States, were developed in the United Kingdom to ease crowding in emergency departments (EDs) by treating patients with less serious injuries.

With as many as 70% of patients presenting to EDs in the United Kingdom being identified as hazardous drinkers, researchers sought to determine the rates of drinkers at MIUs and to assess their thoughts on possible interventions.

The current study defined "hazardous drinkers" (ie, their alcohol intake put them at risk for future harm) as patients consuming at least double the daily recommended units (8 or more for males, 6 or more for females) on 1 or more occasion per week, or those who admitted that their attendance was related to drinking alcohol.

Collecting data from a major London hospital's MIU during a 4-week period, the researchers found that 71.9% of 192 patients who agreed to take part in the study said they drank alcohol, and almost half (49.0%) of those drank more than the amount defined as "hazardous" The hazardous drinkers tended to be younger than 36 years. Ten of the patients (5.3%) attributed their MIU visit to their drinking.

""When asked about interventions, however, only 3.3% of the "hazardous" drinkers said they would accept the offer of help or advice.

The lack of enthusiasm was shared by the staff: Among the 4 (16%) of 25 emergency nurse practitioners staffing the unit who completed questionnaires related to the study, all commented that they did not feel the MIU was an appropriate setting for intervention and brief advice for the drinkers.

The nurse practitioners cited a lack of time for such activity and suggested that patients would be likely to respond negatively if questioned about their alcohol use.

Although the low rate of response by the practitioners is partially explained by absence from the unit at the time of the study (6/25), the authors suggest another factor in the nurse's negative responses could be "clinical inertia."

"Clearly, the [emergency nurse practitioners] involved in this study had a low level of interest in alcohol [intervention and brief advice], and therefore we suggest that lessons learnt about effective implementation in the ED, the provision of training linked to evidence-based practice, and the definition of a clear role for nursing staff could and should be applied in the MIU setting," they write.

The authors add that the reasons for the negative responses from the patients identified as hazardous drinkers are less clear.

"Interestingly, very few participants accepted such an offer [for intervention], and the reasons for this remain unclear, although this may be related to the low numbers of hazardous drinkers who associated their MIU attendance with their alcohol consumption," the authors note.

"However, the prevalence of hazardous alcohol consumption is such that the MIU should be considered alongside EDs as an appropriate location to identify and intervene with patients whose drinking places them at risk of future harm."

The authors have disclosed no relevant financial relationships.

Emerg Med J. Published online December 21, 2011. Abstract

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