Changes in alcohol history taking and management of alcohol dependence by interns at The Royal Adelaide Hospital

Objective The objective of this study is to determine whether the presence of a drug and alcohol unit and comprehensive medical education have made a difference to the detection and management of alcohol-related problems in a general teaching hospital. Methods Data were obtained from hospital case notes before and after the in troduction of the drug and alcohol unit and medical education. Samples of g eneral admissions and admissions with an alcohol diagnosis were obtained. T he outcome measures included alcohol history taking, quantification of alco hol consumption and management of alcohol dependence. Results It was found that for the general admission sample, interns were mo re likely to take an alcohol history, both in the accident and emergency (A &E) department and on the ward, in 1994 compared to 1988. The difference in the A&E department was statistically significant (P = 0.009). In the A&E d epartment in 1994 there was a greater prevalence of alcohol history taking for male patients (odds ratio (OR) 10.09, 95% confidence interval (CI) 1.89 to 53.70, P = 0.007) compared with female patients (OR = 1.81, 95% CI 0.38 to 8.57, P = 0.045). There were no differences in alcohol history taking b y interns in the samples of alcohol-related admissions. There were no stati stically significant differences in the prevalence of documenting alcohol h istories quantitatively in either sample. The use of alcohol withdrawal cha rts, ordering diazepam for alcohol withdrawal and ordering drugs which conf ormed to the hospital formulary all increased significantly by 1994. The pr evalence of ordering thiamine and consulting the drug and alcohol unit both decreased slightly by 1994, but not significantly. Conclusion Improvements have been found in the detection and management of alcohol use since the introduction of the Drug and Alcohol Unit and medical education, but there is still room for further improvement and particular areas where greater attention is needed are identified.