Alcohol use in a general hospital inpatient population

‘Hear no evil, see no evil’

Dr. Kieran O’Loughlin

Background

1133 admissions in an Irish hospital 30% of men and 8% of women met the DSM IV criteria for alcohol abuse or dependence1.

For patients attending accident and emergency the figure may be as high as 40%2.

Background

Screening and brief interventions have been shown to have beneficial effects with respect to long-term outcome in cases of alcohol misuse3.

Hospital-based psychiatric substance use consultations improve engagement in alcohol rehabilitation and treatment outcome4.

In 2006 the Psychiatry of Later Life liaison service in Tallaght Hospital Dublin, received only 8 consultation requests for alcohol misuse (out of a total of 211 requests for psychiatric consultation) representing less than 4% of all referrals.

Objectives

1.

We aimed to determine if poor documentation of alcohol intake is a problem amongst the NCHD (Non-Consultant Hospital Doctor) population in Tallaght hospital.

Objectives

2.

We aimed to assess NCHD’s attitudes towards alcohol misuse to determine if there are specific patient variables which may influence the decision to refer to specialist services.

Objectives

3.

We aimed to assess NCHD’s knowledge of the safe levels of alcohol consumption for both males and females.

Methodology

Part 1 Chart Review

Part 2 Questionnaire

Methodology

Part 2 CASE VIGNETTES– 1. Give no further advice regarding alcohol intake– 2. Advice to cut back on alcohol intake– 3. Advice to abstain from further drinking– 4. Recommend self-referral to alcohol services– 5. Refer to General Practitioner for management– 6. Refer to specialist services

Part 1 - Results

33%

(n=56)

44%

(n=58)

43%

(n=66)

32%

(n=48)

42%

(n=50)

36%

(n=64)

38%

(n=114)

Full alcohol

history with quantity

27%

(n=45)

21%

(n=28)

22%

(n=33)

27%

(n=40)

24%

(n=29)

24%

(n=44)

24%

(n=73)

Alcohol

history but no quantity

40%

(n=68)

35%

(n=46)

35%

(n=53)

41%

(n=61)

34%

(n=41)

40%

(n=73)

38%

(n=114)

No

Alcohol

history

<65

56%

(n=169)

>65

44%

(n=132)

Female

50%

(n=152)

Male

50%

(n=149)

Surgical

40%

(n=120)

Medical

60%

(n=181)

Total

100%

(n=301)

Table 1

Results

The differences demonstrated between all three subgroups in Table 1 (medical vs. surgical, male vs. female, >65 vs. <65) are statistically significant (0.02< p < 0.05 in all cases).

However the relatively large number patients in the ‘alcohol history but no quantity’ subgroup contributes strongly to the calculation of statistical significance.

Implications – Part 1

62% of patients – Quantity of alcohol consumed not documented. – It may represent an attitude amongst NCHDs towards

alcohol intake in certain patient populations as defined by age, gender or the nature of presenting complaint.

– It may represent a lack of awareness on the part of NCHDs as to the importance of taking an alcohol history.

– It may simply represent a lack of knowledge on the part of NCHDs as to how to take an alcohol history.

Results – Part 2

Our questionnaire dealt with treatment issues. 2 case vignettes

– the presenting complaint was consequent upon alcohol misuse

– Case vignette No. 1: 30% – Case vignette No. 5: 78%

(chose option of referral to specialist services)

Results – Part 2

4 Case vignettes – P/C not consequent upon alcohol misuse.

Case vignette No. 2: 12%. Case vignette No. 3: 8% Case vignette No. 5: 4% Case vignette No. 6: 9%

We must concede that the failure of NCHDs to opt for ‘referral to specialist services’ may also indicate a lack of knowledge as to what services are available to them. To what extent this factor influenced the findings of our study is unclear.

Results

95% of NCHDs correctly identified the recommended weekly limit of alcohol consumption for both women and men (14 units and 21 units respectively).

Conclusion

Medical education has been shown to lead to improvements in the detection of alcohol misuse by hospital interns5.

This survey clearly identifies a need for further education of NCHDs with regard to the detection of excessive alcohol intake in their patients.

Conclusion

Implement educational programme.

Complete audit cycle next year.

References

1. Hearne R, Connolly A, Sheehan J. Alcohol abuse: prevalence and detection in a general hospital. J R Soc Med 2002;95:84-87.

2. Conigrave K, Burns FH, Reznik RB, Saunders JB. Problem drinking in emergency department patients: the scope for early intervention. Med J Aust 1991;154:801-5.

3. . Babor TF, Higgins-Biddle JC, Dauser D, Burleson JA, Zarkin GA, Bray J. Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Alcohol Alcohol. 2006 Nov-Dec;41(6):624-31.

4. Hillman A, McCann B, Walker NP. Specialist alcohol liaison services in general hospitals improve engagement in alcohol rehabilitation and treatment outcome. Health Bull (Edinb). 2001 Nov;59(6);420-3.

5. Gaughwin M, Dodding J, White JM, Ryan P. Changes in alcohol history taking and management of alcohol dependence by interns at the Royal Adelaide Hospital. Med Educ 2000; 34(3):170-4.