Assessment of alcohol use patterns among spanish-speaking patients.

OBJECTIVE: The objective of this study was to assess drinking patterns of Spanish-speaking patients using a bilingual computerized alcohol screening and brief intervention (CASI) tablet computer equipped with the Alcohol Use Disorders Identification Test (AUDIT). METHODS: This retrospective study was conducted in a tertiary university hospital emergency department (ED) between 2006 and 2010. Data from 1816 Spanish-speaking ED patients were analyzed using descriptive statistics, the chi-square test for independence, and the Kruskal-Wallis rank sum test for comparisons using quantitative variables. RESULTS: Overall, 15% of Spanish-speaking patients were at-risk drinkers, and 5% had an AUDIT score consistent with alcohol dependency (≥20). A higher percentage of Spanish-speaking males than females were at-risk drinkers or likely dependent. Spanish-speaking males exhibited higher frequency of drinking days per week and higher number of drinks per day compared with females. Among older patients, nondrinking behavior increased and at-risk drinkers decreased. The majority of males and females were ready to change their behavior after the CASI intervention; 61% and 69%, respectively, scored 8-10. CONCLUSIONS: This study indicated that CASI was an effective tool for detecting at-risk and likely dependent drinking behavior in Spanish-speaking ED patients. The majority of patients were ready to change their drinking behavior. More alcohol screening and brief intervention tools should be tested and become readily accessible for Spanish-speaking patients.

Increased detection of alcohol consumption and at-risk drinking with computerized alcohol screening.

BACKGROUND: The impact of alcohol use has been widely studied and is considered a public health issue. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends Screening and Brief Intervention and Referral Treatment (SBIRT), but the actual practice in the Emergency Department (ED) is constrained due to limited provider time and financial resources. OBJECTIVES: To assess the effectiveness of alcohol screening using Computerized Alcohol Screening and brief Intervention (CASI) compared to alcohol screening by triage nurse during Medical Screening Examination (MSE) in the ED. METHODS: Retrospective review of CASI/MSE database from January 2008 through December 2009, collected in the tertiary, Level I Trauma ED was performed. Inclusion criteria included age ≥18 years, and completion of both the MSE and CASI. We analyzed the database by comparing age, gender, primary language (English, Spanish), and Alcohol Use Disorders Identification Test scores using McNemar's test. RESULTS: Data were available for 5835 patients. CASI showed a significant increase in detection of at-risk drinking over MSE across all ages, gender, and primary language (p < 0.05). MSE found 2.5% at-risk drinkers and CASI found 11.5% at-risk drinkers (odds ratio [OR] 8.88, 95% confidence interval [CI] 6.89-11.61). Similar results were found in 18- to 20-year-old patients. MSE identified 1.8% at-risk drinkers and CASI reported 15.94% (OR 19.33, 95% CI 6.30-96.47). CONCLUSION: CASI increased detection of at-risk alcohol drinkers compared with MSE across all ages, gender, and primary language. CASI is a promising innovative method for alcohol screening in the ED for the adult population, including under-aged drinkers.

Computer-Assisted Diabetes Risk Assessment and Education (CADRAE) for Medically Vulnerable Populations in the Middle East: a Novel and Practical Method for Prevention.

The prevalence of diabetes in the Middle East is increasing rapidly due to urbanization, reduced levels of physical activity, and a nutritional transition toward increased consumption of fats and refined carbohydrates. Preventive strategies are of paramount importance to stemming the tide. Portable touch-screen computer technology may hold an answer for alleviating the burdens of cost, time, and training that limit the implementation of diabetes risk screening and intervention, especially among refugees and other vulnerable populations. The Computer-Assisted Diabetes Risk Assessment and Education (CADRAE) Arabic-language intervention program is proposed as a model method for practicing proactive type 2 diabetes prevention in resource-limited settings of the Middle East that combines the efficiency of risk-score screening methods, the advantages of portable computer interface, and the spirit of brief motivational interviewing. This paper aims to describe the theory and novel design of CADRAE-introduced at the Noor Al Hussein Foundation's Institute of Family Health in January 2014-as well as discuss opportunities and challenges for its implementation and evaluation in primary or emergency care settings. Features of CADRAE are elucidated in detail, including development, translation, conceptual framework, theoretical basis, method of risk assessment, brief intervention style, definition of outcomes, requirements for implementation, and potential means of evaluation and quality improvement. CADRAE offers the first example of portable computer technology integrating diabetes risk screening with behavior change counseling tailored for an Arabic-speaking population of mostly refugees and could offer a valuable model for researchers and policy makers of the Middle East as well as other resource-limited settings.