Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence:Pilot randomized trial and qualitative interviews

Background: A large proportion of hospital outpatients is alcohol dependent (AD) but few are engaged in treatment for their drinking. Brief intervention, designed to raise patients’ awareness of their drinking, might encourage uptake of referral to specialty treatment. We assessed the feasibility of conducting a randomized trial evaluating the effectiveness of electronic brief intervention on the uptake of specialty treatment in hospital outpatients with likely AD. Methods: This study was conducted in the outpatient department of a large public hospital in Newcastle, Australia. We randomly assigned adults who scored ≥10 on the AUDIT-C and were not currently receiving treatment for their drinking to electronic brief intervention (comprising an assessment of their drinking and personalized feedback) and referral (n=59), or to referral alone (n=64). We pre-specified two co-primary outcomes as the proportions of patients who (1) accepted and (2) attended a Drug & Alcohol outpatient clinic appointment. We interviewed 15 study participants to investigate why they had declined the appointment and what sort of help they might prefer to receive. Results: Ten patients (five in each group) accepted an appointment, and one patient (control) attended. Most interviewees’ did not see their drinking as a problem or were confident they could manage it by themselves. Those who identified a preferred source of help expressed a preference for treatment by a GP. Conclusion: Uptake of specialty treatment in hospital outpatients with likely AD was low regardless of whether they received brief intervention. Accordingly, a large randomised trial does not appear to be feasible. Registration: Australian New Zealand Clinical Trials Registry ANZCTRN 12612000919819 Keywords: alcohol dependence, outpatients, screening, brief intervention, referral, electronic