Early intervention for alcohol misuse: encouraging doctors to take action

An early intervention programme was introduced to improve the detection and management of problem drinkers admitted to acute orthopaedic wards at Dunedin hospital.

Intervention included brief staff education and the integration of an alcohol screen into the general patient assessment form used by junior doctors. Two hundred sets of patient records were examined, half before, and half after the introduction of these changes. Information was collected on the adequacy of alcohol history taking, whether alcohol misuse was identified, and how misuse was addressed.

The proportion of patients with an adequate, quantitative alcohol history recorded increased from 37% to 84%. Although the detection of hazardous drinking increased only slightly, the proportion of cases where some form of action was taken increased from 14% to 71%. The majority of cases referred for follow up in the latter period were younger, nondependent problem drinkers. The programme was initially successful, but over time practices tended to revert when active encouragement was withdrawn.

Our findings, consistent with those obtained overseas, indicate a striking plasticity of hospital junior doctor practice. Improvements in the detection and management of alcohol misuse are possible, but appear to require dedicated input and coaching. When such input is withdrawn, reversion can be disappointingly rapid. We suggest that if improved practices are to be sustained, preventive approaches need to be given greater emphasis in medical school curricula, and promoted by both senior medical staff and hospital management.