Delivering an Evidence-Based Intervention to Latino Patients with Alcohol Use Disorders
By Dorothy Brooks, Special for ReliasMedia.com
Data suggest Latino Americans experience relatively high rates of alcohol-related adverse consequences. In recent years, that heavy drinking pattern among this population has grown worse. Further, while emergency departments (EDs) regularly see the consequences of excess alcohol use, efforts to effectively address this problem through screening, brief intervention, and referral to treatment (SBIRT) interventions can be hampered by time constraints, resource shortages, and language barriers.
However, compelling research suggests an automated, bilingual, computerized alcohol screening and intervention (AB-CASI) tool can surmount many of these obstacles and deliver superior results when compared to standard care, consisting primarily of an information sheet and recommended primary care follow-up.
In a randomized clinical trial that included 840 Latino ED patients who reported unhealthy drinking patterns, those who received the AB-CASI intervention recorded significantly fewer episodes of binge drinking within the last 28 days than patients who received standard care at one-year following their ED encounters.
While the AB-CASI tool used in the study is not yet widely available, researchers noted their findings suggest automated tools of this sort offer a viable approach for addressing alcohol-related healthcare disparities in busy EDs.
“Historically, most previous work [using SBIRT for alcohol use] has been done with person-to-person communication,” explains Federico Vaca, MD, MPH, executive vice chair of emergency medicine at the University of California Irvine School of Medicine in Orange, CA. “A physician, a nurse … a paraprofessional or someone else who is trained in delivering behavioral interventions engages the patient in a discussion about alcohol use and their health.”
Other studies have shown SBIRT delivered person-to-person is effective at reducing alcohol consumption and alleviating the adverse consequences from excessive drinking. In his study, Vaca notes participants randomized to the intervention group received a computer tablet that included an application containing the AB-CASI intervention. Participants could choose whether to complete the tool in English or Spanish.
“It would actually engage patients in conversation, asking them if it was OK to talk with them about alcohol and their health,” Vaca explains. “One of the main [parts] of the tool is the screening piece. That’s where the tool assesses the patient by asking a set of 10 questions.”
The screening portion of the tool is actually the Alcohol Use Disorders Identification Test, a validated instrument that delivers a score that categorizes patients with mild, moderate, or severe alcohol use disorder. “Once the score is given to the patient [by the automated tool], it will actually tell them what the score means with respect to their health,” Vaca says.
Based on the answers the patient provides regarding how he or she uses alcohol, the tool will move into more discussion. “We actually try to get patients to consider where they are with alcohol and their health, how it might benefit them to decrease their alcohol use, and what sorts of things might prompt them to make that type of change,” Vaca says.
The tool is interactive. There is logic branching, which allows a patient with mild or moderate alcohol use to choose different pathway than a patient with a severe alcohol use disorder. Vaca says the hope is patients with severe alcohol use disorders will accept a referral for specialized alcohol treatment on the day of the ED visit. “The tool is basically trying to get them to understand where they are and to reflect on that,” he says. “It is part of motivational interviewing, and it is integrated into what is called the brief negotiation interview.”
The automated assessment/intervention only takes eight to 10 minutes to complete. Patients receive a printout reiterating their score, what it might mean for their health, and recommendations for how they can improve their health based on the data.
While the AB-CASI tool works for both English and Spanish speakers, it addresses a major barrier for many EDs that see Spanish-speaking Latino patients with alcohol use disorders, but lack interpreters on site who can help clinicians engage in productive SBIRT discussions.
Further, given many EDs do not have the resources to provide SBIRT in the ED, the automated tool provides a way around that barrier. “If it is a person-to-person interaction, you’ve got to hire somebody. You’ve got to train them to not only deliver the intervention, but also deliver it with high fidelity, meaning that all the components are delivered to the patient every time,” Vaca says. “When the tool is automated, it delivers the intervention with high fidelity. Patients get all the parts of the intervention, all the time, that are appropriate to the patient’s status of alcohol use disorder.”
Technology has advanced significantly since this trial began in 2014. Vaca is considering updating the tool and completing a second trial at multiple sites. Meanwhile, he is advising colleagues in the ED to familiarize themselves with the tools and information available through the National Institute on Alcohol Abuse and Alcoholism. “That’s one place where you can get up to speed on alcohol use disorder and what you can do in the ED with a simple conversation,” Vaca explains.
In addition, Vaca stresses it is critical for clinicians in the ED to put resources in place for patients who request help for their alcohol use disorders. That way, clinicians can direct them to treatment services in the community. “This is a big issue across different racial and ethnic groups, and people who speak different languages,” Vaca observes. “Some communities have treatment resources, but not bilingual services or the ability to provide services in multiple languages, but you don’t know until you start asking.”
For more on this and related subjects, be sure to read the latest issues of ED Management.