Alcohol use in a general
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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 dependence 1 .

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Background 4410344

Alcohol use in a general hospital inpatient population ‘Hear no evil, see no evil’Dr. Kieran O’Loughlin


Background

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.


Background1

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.


Background 4410344

  • 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

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.


Objectives1

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.


Objectives2

Objectives

  • 3.

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


Methodology

Methodology

  • Part 1Chart Review

  • Part 2Questionnaire


Methodology1

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


Results

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

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

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 21

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%


Background 4410344

  • 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.


Results1

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

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.


Conclusion1

Conclusion

  • Implement educational programme.

  • Complete audit cycle next year.


References

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.


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