Abstract
Objectives: To examine the effect of referral to an alcohol health worker (AHW) on levels of alcohol consumption, A&E attendance, psychiatric morbidity and quality of life among patients identified as hazardous drinkers Design: Single Blind Pragmatic Randomised Controlled Trial. Methods: 5240 patients attending the accident and emergency department (AED) over a oneyear period were screened using the Paddington Alcohol Test (PAT). Participants randomised to the Treatment condition were given an AHW appointment and the HEA leaflet ‘Think about drink’. Control participants were given the leaflet, but no appointment. At six months alcohol consumption (PAT and Form 90 AQ) and psychiatric morbidity (GHQ-12); at 12 months alcohol consumption and quality of life (EQ-5D) were assessed. Hospital data was used to determine re-attendance. An analysis of costs associated with screening patients, attending an AHW session and AED attendance was undertaken. Analysis: 599 of 1167 hazardous drinkers met inclusion criteria and were randomised. Thirty-six per cent were lost to follow-up. Data was analysed on an intention to treat basis. Participants in the Treatment condition had significantly lower levels of consumption than Controls at six-month follow-up. Treatment participants attended the AED significantly less often than Controls; a number needed to treat analysis found that every two patients referred to the AHW prompted one less re-attendance. There were no significant differences between groups on the GHQ-12 or EQ-5D. Conclusions: Screening and brief intervention for alcohol misuse in the AED is feasible and results in lower levels of alcohol consumption over the following 12 months. Reduced alcohol consumption is associated with lower levels of reattendance in the AED, which in turn offsets the costs of screening and providing brief intervention.