England's national alcohol strategy published in 2004 recognised that at peak times around 40% of accident and emergency department admissions are alcohol-related, rising to 70% in the early hours. Departments were seen as one site for expanded screening and brief intervention, but a specific recommendation was missing from later commissioning guidance. However, in 2007 a strategy update announced trials of advice-giving at nine accident and emergency departments. In 2008 an audit of alcohol health service provision in England found that outside the trials, such initiatives were rare. Commissioners have reportedly found it hard to persuade staff to undertake this work. The best researched example is the programme at St. Mary's hospital in London, which uses trained and motivated (performance feedback is important) emergency unit staff to screen suspected heavy drinkers or patients with complaints linked to heavy drinking. Doctors explain to positive screen patients that drinking is damaging their health and offer an appointment with an on-site alcohol counsellor, typically the same or the next working day. In these circumstances, two-thirds of patients attend for advice. Offering this service was found to reduce later drinking and return visits to the department. This last finding may be attractive to commissioners seeking to meet national targets to reduce alcohol-related hospital admissions. Further analysis based on the same study found that total public service costs and productivity losses over the following 12 months were roughly equivalent whether or not the intervention was offered, but that offering it was the most cost-effective option for reducing drinking. The latest report from the unit demonstrated the at least temporary feasibility of tasking reception staff to hand out screening questionnaires to all adult ambulant patients, and the willingness of over half the patients to fill in and return the forms.
The Scottish Government has set a target for the health service of delivering 149,449 brief interventions during 2008/09–2010/11 in the priority areas of primary care, antenatal care, and accident and emergency departments. National practice guidelines say emergency patients who screen positive for risky drinking should be encouraged to seek further medical advice, but stop short of recommending routine screening or brief intervention, partly because uptake of such interventions is very low when the burden of implementing them is placed on a department's routine staff.
The Welsh strategy recognised the potential value of brief alcohol interventions in accident and emergency departments, but its action plan made no commitment to their expansion; neither did the strategy for Northern Ireland.
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