Monitoring alcohol-related injuries for prevention Dr. Birgitte M. Blatter, epidemiologist, manager Monitoring & Research

Transcription

1 Monitoring alcohol-related injuries for prevention Dr. Birgitte M. Blatter, epidemiologist, manager Monitoring & Research

2 Content 1. Background 2. Methods and results: a. Monitoring intoxications and alcohol-related injuries in LIS b. Pilot project Monitoring for policy in the East of the NL c. Tailor-made screening and secondary prevention 3. Discussion and conclusions

3 Background

4 Background Alcohol intoxications 10-17yrs ,200 NSCK LIS* 1, Increase in children < Nuisance at ED due to drunken and intoxicated patients 3. Since 2014 municipalities responsible for enforcement of Law on alcohol 4. EDs ask about alcohol use but do not monitor as a standard procedure

5 National Injury Surveillance System (LIS) 14 EDs in the NL (about 15%) Injuries/intoxications: cause (private, work, sport, traffic, violence, automutilation) + reasons Information from Hospital Information System, autotext recognition system to define variables Extrapolation to national figures Application of an incidence-based cost-model: medical costs, work absence, quality of life Case-control studies, case-referent studies For national and regional policy-making

6 1 Monitoring alcohol intoxications and related injuries in LIS Registry of pediatricians of children admitted to hospital due to alcohol will stop (time consuming) In LIS intoxications are already registered but quality / definiton? Goal to implement Alcohol-module step-by-step: 1. Intoxication? 2. Alcohol consumption 6 hours before injury? 3. Amount of alcohol consumption? 4. Where was alcohol consumed? (< 18) 5. Where was alcohol purchased? (<18) 6. With whom was alcohol consumed? (<18)

7 1 Definition and results Definition did not exist intoxication: visiting the ED because of effects in the body of the alcohol itself: unconscious, sick (and no self harm) alcohol-related injury: visiting the ED because of injury and having consumed alcohol / being drunk Some hospitals have implemented the whole module Most are interested but fear the administrative burden: Triage information might be taken over

8 Trends in ED visits in NL: Alcohol intoxications and alcohol related injuries 16,000 14,000 12,000 10,000 Alcohol related injuries 8,000 Alcohol intoxications 6,000 Alcohol intoxications 0-17 years 4,000 2,000 0

9 1 Trend in ED visits in NL due to alcohol intoxications: with confidence intervals 8,000 7, , ,000 4, ,000 2,000 1,

10 2 Pilot: Monitoring alcohol for regional policy making Municipality was interested in the data Alcohol module was implemented, questions asked by nurses and physicians

11 2 Results pilot: Monitoring alcohol for regional policy making 190 cases alcohol, of which 23 intoxication 9 cases drugs 4 cases combination of alcohol and drugs Location of alcohol consumption at home public venues unknown 88 Origin of alcohol cafe or bar friends different at home 0-14 years years years

12 2 Pilot: Regional policy making on prevention of alcohol abuse? Municipalities struggled with their role in enforcement and prevention Acquiring information on target groups? Monitoring effect of policy? Law enforcers? Sale of alcohol to minors prohibited (in supermarkets and cafés or bars) Initiating campaigns for schools, sports canteens, policy on drinking barns Financial question?

13 3 Screening and secondary prevention Investigation: Conditions for implementation are: quick, simple, integrated into processes at the ED, tailor-made (dependent on local issues) Which instrument for screening? General alcohol consumption with Audit-C or alcohol use prior to injury? Literature: Hand a leaflet with information on addiction care is effective, motivational interviewing no added value National directive of protocol is desirable Two hospitals started with pilot: Amsterdam and Tilburg Bron: Croes, Voorham, Klein Wolt, Tussenrapportage 2015

14 3 Results pilot: Screening and secondary prevention Amsterdam: leaflet developed, screening with Audit-C, inclusion just started a few months Tilburg: preparations for leaflet, screening about to start Third hospital being approached No quantitative results of effects

15 Discussion and conclusion Alcohol-related injuries are a hot topic, many institutes are interested (also in relation to traffic injuries, violence incidents) It is not easy to acquire data through EDs, but not impossible either (long-term projects, integrating data collection in standard procedures) Municipalities differ in how they see their role in prevention of alcohol abuse (small municipalities versus Amsterdam) Secondary prevention via Emergency Departments promising but also long-term routes

16 Thanks for your attention Questions?

17 What is VeiligheidNL? Expertise center for safe behaviour in a safe environment Monitoring trends and causes of injuries WHAT: our approach HOW: we make sure that safe behaviour is natural WHY: A safe home, travel and work environment, for everybody by stimulating people in a positive way Development of interventions to stimulate safe behaviour We share knowledge with several target groups

18 Alcohol consumption, age first time alcohol use and bingedrinking in year-olds 2011 vs 2015 Bron: European School Project on Alcohol and other drugs, april 2016

19 Trend of ED visits according to cause of injury 700, ,000 Privé-ongevallen 500,000 Sportblessures Verkeersongevallen 400,000 Arbeidsongevallen 300,000 Geweldpleging Zelfbeschadiging 200, ,000 0

20 Trend of ED visits according to type of injury 450, , , , ,000 Fractuur 200, , ,000 Oppervlakkig letsel Open wond Distorsie Hersenletsel Overig/ onbekend 50,000 0