Brief Intervention in the ER in Poland

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DESCRIPTION (provided by applicant): The aims of this Developmental Grant Proposal for Collaborative International Projects are to: 1) examine the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) using a nurse-delivered motivational intervention, relative to standard care with and without assessment, on a reduction in heavy drinking (drinking days per week, number of drinks per day, maximum number of drinks on an occasion) and alcohol-related problems (RAPS4 and SIPS + 6) in the emergency room (ER) in Sosnowiec, Poland; and, 2) identify variables that are related to effectiveness of the intervention and that predict successful treatment outcome. We plan to translate motivational interventions that have been successful in primary care and which were recently implemented in the U.S. 14 Academic Emergency Medicine SBIRT study to a non-academic ER setting outside of the U.S. The SBIRT study, recently funded by NIAAA and SAMHSA, is the first multisite, collaborative study of screening, brief intervention and referral for at-risk and dependent drinking in the ER. We will conduct a blinded randomized brief motivational intervention trial in which both injured and noninjured patients over the aged of 18 will be screened for at-risk or dependent (using the RAPS4) drinking. Those screening positive will be asked to participate in the study. Consenting patients will be randomized into one of three groups: screened only, assessed, and brief intervention, with n=292 in each group. Intervention and assessment groups will be followed-up at 3 months and all three groups at 12 months. Modifying variables include drinking in the event, risk taking disposition and readiness and stage of change. Prior research in the ER in Sosnowiec and a pilot feasibility study of SBIRT in Sosnowiec suggest: 1) a large number of "at risk", heavy problem and dependent drinkers who meet screening criteria for brief intervention in a relatively short period of time; 2) a socialized health care system which provides equal access to care and is not subject to selection bias affecting patient access; 3) a patient sample covering a large geographic area; 4) a stable environment facilitating high follow-up rates post-intervention; and, 5) a well integrated referral system and high accessibility to alcohol treatment services. Outcome data will be analyzed using ANOVA, logistic regression and Generalized Estimating Equations. The interaction of modifying variables on outcomes will also be analyzed. The ER is an important setting for screening and brief intervention for those with alcohol-related problems in order to reduce subsequent alcohol-related ER visits and associated costs and increase quality of life. This project will inform the development and spread of more effective techniques and protocols for addressing at-risk and dependent drinking in the ER, and provide a better understanding of those factors that influence effectiveness of brief intervention and predict successful patient outcomes.