Academic journal article Alcohol Research

Putting the Screen in Screening: Technology-Based Alcohol Screening and Brief Interventions in Medical Settings

Academic journal article Alcohol Research

Putting the Screen in Screening: Technology-Based Alcohol Screening and Brief Interventions in Medical Settings

Article excerpt

Alcohol-related screening and brief interventions (SBIs) in medical settings have the potential to transform the treatment of alcohol misuse and prevent considerable alcoholrelated harm (Babor and Higgins-Biddle 2001). Rapid screening and assessment tools allow health care providers to quickly assess the extent of patients' alcohol use, identify those with problematic use, provide them with an immediate brief intervention, and refer patients with more severe alcohol use disorders to a substance abuse specialist when available. SBIs have proven effective for detecting potential alcohol problems and reducing the severity of problems in a wide range of populations and settings (Kaner et al. 2009; O'Donnell et al. 2014)-so much so that agencies focused on preventing and treating alcohol use, including the U.S. Preventive Services Task Force (USPSTF), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), recommend that primary care and other medical settings expand their SBI use for patients ages 18 years and older (Moyer 2013; NIAAA 1995; SAMHSA 2011). Although the USPSTF cited insufficient evidence to recommend SBIs for adolescents (Moyer 2013), recognition of and evidence for the potential utility of SBIs for adolescents have been building in recent years (Harris et al. 2012; Mitchell and Gryczynski 2012; Pilowsky and Wu 2013), leading the American Academy of Pediatrics to recommend that all pediatricians use SBIs in their practices as part of routine care (American Academy of Pediatrics 2011).

Despite the push for using SBIs in medical settings, they remain underused. In a recent national survey of U.S. adults, only one in six (15.7 percent) respondents reported discussing alcohol use with a health professional in the past year, with State-specific estimates ranging from 8.7 percent to 25.5 percent (McKnight-Eily et al. 2014). The percentage was higher (34.9 percent), but still inadequate, among those with 10 or more binge-drinking episodes in the past month. An often-cited barrier to SBI implementation is lack of time (Van Hook et al. 2007; Wilson et al. 2011). Computer-facilitated SBI delivery may offer a solution for busy medical settings, allowing more widespread implementation. This article focuses on current- and emergingtechnology-facilitated SBI tools that have been evaluated in primary care, pediatric, and emergency department (ED) settings. We review studies of technology-based SBI as they relate to adults (18 years or older), pregnant women, and adolescents (17 years or younger), the primary patient populations in which alcohol SBIs have been implemented. The studies reviewed here come from a systematic electronic literature search conducted between February 2014 and December 2014 using PubMed and PsycINFO, as well as the reference lists of published studies and review articles. We summarize the characteristics of the studies, including population, design, and results, in the table.

Value Added With Electronic SBIs

Technology-based SBIs could help increase the frequency and quality of SBI use in medical settings by enhancing efficiency and standardizing implementation. In terms of screening, touchscreen devices or standalone computers with Internet connections can allow patients to enter information in the waiting room prior to an appointment. Programs automatically score the screening results that staff can print or electronically transmit to practitioners. This reduces clinician time needed for administering and scoring a questionnaire during the visit. In addition, programs can be loaded with validated measures that improve the quality of screening and can automatically select appropriate questions according to the patient's age and previous responses. Patients also may be more willing to disclose sensitive information to a computer than to a person (Butler et al. 2009; Turner et al. 1998), and integration of computerized screening results with electronic health records may boost screening and documentation rates (Anand et al. …

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