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Kiosk versus in-person screening for alcohol and drug use in the emergency department: patient preferences and disclosure.

Hankin A, Haley L, Baugher A, Colbert K, Houry D - West J Emerg Med (2015)

Bottom Line: Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use.ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer.Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.

View Article: PubMed Central - PubMed

Affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.

ABSTRACT

Introduction: Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview.

Methods: This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test.

Results: A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort.

Conclusion: ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.

No MeSH data available.


Related in: MedlinePlus

Patient flow diagram of participation in alcohol and drug use screening, using kiosk and in-person modalities.WR, waiting room
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f1-wjem-16-220: Patient flow diagram of participation in alcohol and drug use screening, using kiosk and in-person modalities.WR, waiting room

Mentions: For participation in the in-person screening, a trained RA was present in the ED Monday through Friday, 9am–5pm. The RA approached eligible patients in both the ED waiting room and in patient care rooms during naturally occurring downtime in the patient’s medical care (such as while awaiting lab or imaging tests to occur or while awaiting test results). Patients were eligible for in-person screening participation regardless of prior completion of the kiosk screening. When approached for in-person screening, participants were informed that the RA was surveying people about health behaviors and survey modality preferences, and that participation was voluntary, confidential, and any choice to agree/decline to participate would have no bearing on the patients’ medical care. All participants provided signed informed consent (Figure 1).


Kiosk versus in-person screening for alcohol and drug use in the emergency department: patient preferences and disclosure.

Hankin A, Haley L, Baugher A, Colbert K, Houry D - West J Emerg Med (2015)

Patient flow diagram of participation in alcohol and drug use screening, using kiosk and in-person modalities.WR, waiting room
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4380369&req=5

f1-wjem-16-220: Patient flow diagram of participation in alcohol and drug use screening, using kiosk and in-person modalities.WR, waiting room
Mentions: For participation in the in-person screening, a trained RA was present in the ED Monday through Friday, 9am–5pm. The RA approached eligible patients in both the ED waiting room and in patient care rooms during naturally occurring downtime in the patient’s medical care (such as while awaiting lab or imaging tests to occur or while awaiting test results). Patients were eligible for in-person screening participation regardless of prior completion of the kiosk screening. When approached for in-person screening, participants were informed that the RA was surveying people about health behaviors and survey modality preferences, and that participation was voluntary, confidential, and any choice to agree/decline to participate would have no bearing on the patients’ medical care. All participants provided signed informed consent (Figure 1).

Bottom Line: Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use.ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer.Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.

View Article: PubMed Central - PubMed

Affiliation: Emory University, Department of Emergency Medicine, Atlanta, Georgia.

ABSTRACT

Introduction: Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview.

Methods: This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test.

Results: A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort.

Conclusion: ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.

No MeSH data available.


Related in: MedlinePlus