CAMBRIDGE, ONT. - If you suspect a patient has a drinking problem, try asking about how frequently they injure themselves rather than how much they drink.
A study using this approach was successful in identifying alcoholic patients who otherwise might have been missed, and, at the same time, made broaching the subject easier for doctors.
The study of 15,000 patients treated for trauma here, was done by researchers in Toronto and Philadelphia.
The idea for using trauma as a topic of discussion, instead of drinking habits, stems from earlier studies that found close to 40% of all trauma injuries (outside of sports) are connected to alcohol use, said Dr. Yedy Israel (PhD), an addiction researcher and professor of pathology at Philadelphia's Thomas Jefferson University.
Dr. Israel, formerly of the Addiction Research Foundation in Toronto, was behind a Canadian study a few years ago in which alcoholics were X-rayed to determine how many times they had broken or fractured bones. X-rays of nonalcoholic patients at The Toronto Hospital, Western Division, were used for comparison.
That study found alcoholics had 15 times the number of broken bones compared to nonalcoholics, Dr. Israel said.
Taking this further, it seemed asking about personal trauma history might be a way to find out which patients may have a drinking problem.
In Cambridge, a town about 100 km west of Toronto, doctor-nurse teams were asked if they would participate in a research project in which patients would be asked four questions about trauma. Forty-two doctors participated.
Patients were asked if they had any fractures or dislocations in the past five years, whether they had been injured in traffic accidents, if they had any head injuries in the past few years, and whether they had been in a fight or had been assaulted.
If patients answered yes to two or more of the questions, or had been injured several times in the past few years, the doctors would then ask more questions.
"The doctor could express concern about the patient's lifestyle without having to focus directly on drinking habits," Dr. Israel said. If the patient was having more than two drinks a day, exceeded 18 drinks per week, or had other indicators of a drinking problem, he or she would be referred to a lifestyle nurse.
The approach, Dr. Israel said, may be easier for doctors who might feel awkward asking patients about their drinking habits. It is also an easier approach for patients who may otherwise be offended or defensive about their drinking habits.
For the study, lifestyle nurses were trained on how to deal with the patients. They would give the patient a 45-minute assessment, and show them how to keep track of their drinking. Patients had repeated consultations with the nurses during the course of a year.
A control group was included in the study. They also had drinking problems, but instead of being referred to nurse intervention, patients were given a pamphlet about drinking to take home.
At the end of a year, patients who had the intervention had 35% fewer visits to the doctor than the control group. They also had cut the amount they were drinking by about 70%, compared to 40% in the control group, Dr. Israel said.
Blood tests to assess liver abnormalities associated with alcohol abuse were also used. Gammaglutamyl transferase, for example, was reduced between 35% and 60% for the intervention group, Dr. Israel said.
Study results were published in a recent edition of the journal Alcoholism: Clinical and Experimental Research (Nov. 15, 1996).
Copyright © 1996 Maclean Hunter Publishing Limited
Reprinted with permission.
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