Improving Alcohol Screening with Technology

By Anna Lynn Spitzer

Irvine, CA, July 3rd, 2013 -- Alcohol consumption is a costly problem in the United States, in terms of both dollars and cents, and the resulting health impacts. In California alone, alcohol-related injuries, illnesses and trauma tops $38 billion annually – the equivalent of $1,000 per resident.

Even more disturbing, according to National Highway Traffic Safety data, an alcohol-related automobile crash occurs every 2 minutes and an alcohol-related fatality occurs every 31 minutes. 

Dr. Shahram Lotfipour, a UC Irvine emergency department physician, spoke about the problem to a group of Calit2 students, faculty and staff this week in the first of this summer’s SURF-IT lunchtime symposia. 

Lotfipour, who also serves as the medical school’s associate dean for clinical science education, is affiliated with a university center for trauma and injury prevention research. 

He and his team are testing the effectiveness of a computer-based screening, intervention and referral platform called CASI -- Computerized Alcohol Screening and Brief Intervention.

“Unfortunately, when it comes to vehicle collisions, assaults, crime, pedestrian injuries, bicycle injuries, etc., alcohol is a major factor,” he said. “In the ED, we usually assume, when somebody comes in with an acute injury, that alcohol has been involved, either with them or the person who injured them.”

Screening for alcohol is mandatory in trauma centers; it is required by the American College of Surgeons, which certifies the centers.

Lotfipour said most alcohol consumption screenings don’t do much in the way of intervention, however. Reams of data are available to document the effects of alcohol abuse but to him, the bigger question is how to bring about much-needed change. 

“That’s part of the emphasis in our center: what health interventions can we do that will make a difference?”
CASI is based on a national screening protocol called AUDIT: Alcohol Use Disorder Identification Test, a 10-question survey approved by the World Health Organization given to hospital, clinic and trauma patients. The problem with using AUDIT alone, according to Lotfipour, is that the questionnaire focuses more on an historical look at a patient’s alcohol consumption and less on implementing change.

UCI’s CASI effort began in 2006 on a large computer wheeled from patient to patient. It has evolved into a touch-screen tablet application available in English and Spanish, which uses patients’ own motivations in an attempt to change their behavior. “We try to involve their own problems in the solution,” Lotfipour said. 

Patients are given pertinent information about alcohol consumption, then asked to identify their own related health issues. They are also asked if they are willing to reduce or eliminate the alcohol consumption that is contributing to these issues. “It’s a motivational interview,” Lotfipour explained. “We’re saying, ‘how do you want to go about changing these things that are bothering you?’”

Patients are given a printed summary of the questionnaire responses as well as informational handouts. They are also followed at 6-month and one-year intervals.

Studies have shown that physician and/or healthcare provider feedback and advice is a powerful motivation. “This kind of intervention – one single encounter -- can reduce alcohol use for at least 12 months,” Lotfipour told the audience, and has similar effects regardless of age, gender or ethnicity.

This type of encounter has also been proven to reduce sick days, drinking-and-driving incidents and alcohol-related problems of other kinds. “The medical encounter is too important a prevention opportunity to miss,” he said.

CASI is simple and quick – it takes fewer than seven minutes to complete the questionnaire – and follow-up interviews indicated that 92 percent of patients found it easy to use. When asked if they preferred to have a human administer the screening, more than 75 percent answered no.

Follow-up interviews revealed a measure of success as well.  Half of those who drank more than recommended ranked themselves at an 8 on a 10-point readiness-to-change scale. Those patients who had committed to changing their behavior on their CASI questionnaires actually had done so, cutting back on the number of drinks they consumed or eliminating alcohol entirely. 

More alcohol screening and brief intervention opportunities are needed, Lotfipour said, or the associated costs will continue to 
rise. He believes the future of these efforts is in more portable, hand-held devices. “The more information we can put into patients’ hands, the higher the likelihood of making it interesting, available and viable to them.”