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Randomized Controlled Trial of Mailed Personalized Feedback for Problem Drinkers in the Emergency Department: The Short-Term Impact

Authors

  • Alys Havard,

    1. From the National Drug and Alcohol Research Centre (AH, APS, KMC, CMD), University of New South Wales, Sydney, NSW, Australia; and Drug Health Service (KMC), Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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  • Anthony P. Shakeshaft,

    1. From the National Drug and Alcohol Research Centre (AH, APS, KMC, CMD), University of New South Wales, Sydney, NSW, Australia; and Drug Health Service (KMC), Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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  • Katherine M. Conigrave,

    1. From the National Drug and Alcohol Research Centre (AH, APS, KMC, CMD), University of New South Wales, Sydney, NSW, Australia; and Drug Health Service (KMC), Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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  • Christopher M. Doran

    1. From the National Drug and Alcohol Research Centre (AH, APS, KMC, CMD), University of New South Wales, Sydney, NSW, Australia; and Drug Health Service (KMC), Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Reprint requests: Alys Havard, PhD, School of Medicine, University of Western Sydney, Sydney, NSW, Australia; Tel.: +61-2-4620-3907; Fax: +61-2-4620-3891; E-mail: a.havard@uws.edu.au

Abstract

Background:  Evidence exists for the efficacy of emergency department (ED)-based brief alcohol interventions, but attempts to incorporate face-to-face interventions into routine ED practice have been hampered by time, financial, and attitudinal constraints. Mailed personalized feedback, which is likely to be more feasible, has been associated with reduced alcohol consumption in other settings, but its cost-effectiveness in the ED has not been examined.

Methods:  The intervention was evaluated with a randomized controlled trial of patients presenting to 5 rural EDs in New South Wales, Australia. Patients aged 14 years and older were screened using the Alcohol Use Disorders Identification Test, and those scoring 8 or more were randomly allocated to the intervention or control group. Participants in the intervention group received mailed personalized feedback regarding their alcohol consumption. The control group received no feedback.

Results:  Two hundred and forty-four (80%) participants were successfully followed up at 6 weeks. A significant effect of the mailed feedback was observed only in patients with an alcohol-involved ED presentation. Among this subgroup of participants, those in the intervention group consumed 12.2 fewer drinks per week than the control group after controlling for baseline consumption and other covariates (effect size d = 0.59). The intervention was associated with an average cost of Australian $5.83 per patient, and among participants with an alcohol-involved ED presentation, an incremental cost-effectiveness ratio of 0.48.

Conclusions:  Mailed personalized feedback is efficacious in reducing quantity/frequency of alcohol consumption among patients with alcohol-involved ED presentations. Mailed feedback has high cost-efficacy and a low absolute cost, making it a promising candidate for integration into ED care.

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