Bilingual digital tool reduces binge drinking episodes among Hispanic patients

Key takeaways:

• Hispanic patients who received care with the tool had fewer binge drinking episodes at 12 months vs. those who received standard care.
• The intervention may reduce health disparities in EDs.

The use of an automated bilingual digital health tool significantly reduced the number of binge drinking episodes among Hispanic patients in the ED, representing a viable option for addressing health disparities, according to researchers.

There is a high prevalence of alcohol use disorder (AUD) and related health disparities in EDs across the United States health system, particularly among Hispanic individuals, Federico E. Vaca, MD, MPH, a professor in the department of medicine at the Yale School of Medicine, and colleagues wrote in JAMA Network Open.

ED screening, brief intervention and referral to treatment (ED-SBIRT) have previously been associated with decreased alcohol consumption, but there are barriers to implementation in emergency care settings, according to the researchers.

“The inability to deliver the intervention in the patient’s preferred language is a fundamental rate-limiting step,” they wrote. “Without language concordance, meaningful patient communication about unhealthy alcohol use and disease prevention is a failed endeavor.”

To address implementation shortcomings, Vaca and colleagues conducted an unblinded, parallel-group randomized clinical trial to test an automated bilingual computerized alcohol screening and intervention (AB-CASI) that was developed for ED-SBIRT.

They wrote that after patients selected their preferred language, the tool administered an Alcohol Use Disorders Identification Test, a brief negation interview and concluded with an alcohol reduction plan and referral information.

The study consisted of 840 Hispanic patients (mean age, 36 years; 51.5% men) who tested positive for unhealthy drinking. Of those, 418 were randomly assigned to AB-CASI, while the remaining were given standard care.

Overall, mean binge drinking episodes were significantly lower for AB-CASI participants vs. patients with standard care at 12 months after 28 days (relative difference = 0.79; 95% CI, 0.64-0.99).

The researchers found that for AB-CASI participants, the mean number of binge drinking episodes within the past 28 days decreased from 7.7 (95% CI, 6.9-8.7) at baseline to:

• 3.5 (95% CI, 3.0-4.2) at 1 month;
• 3.4 (95% CI, 2.9-4.1) at 6 months; and
• 3.2 (95% CI, 2.7-3.8) at 12 months.

Among participants receiving standard care, the mean number of binge drinking episodes at baseline decreased to:

• 3.9 (95% CI, 3.3-4.6) at 1 month;
• 3.1 (95%CI, 2.6-3.7) at 6 months; and
• 4 (95% CI, 3.4-4.7) at 12 months.

“More than one-half of the participants chose to receive AB-CASI in Spanish,” the researchers wrote. “In the current state of national ED-SBIRT implementation, it is plausible that this specific vulnerable group would not have received intervention due to the limitations of ED-SBIRT delivery in Spanish and intervention knowledge.”

Vaca and colleagues also highlighted the intervention’s feasibility and cost-effectiveness.

“A recent study found that ED-SBIRT can be an effective cost-reducing strategy to address unhealthy alcohol use, and the authors advocated for policy makers and payers to prioritize these types of interventions,” they wrote.

The researchers additionally noted that the tool was associated with larger reductions in mean binge drinking episodes among adults aged older than 25 years compared with younger adults.

“Given the smaller subgroup of participants 25 years or younger (n = 176), further investigation of the impact of the intervention in younger individuals with unhealthy drinking is warranted,” they concluded.