Transcript Department of Addiction Medicine Current services

#alcoholharmED
Opening address
Dr Andrew Walby
Director of Emergency Medicine,
St Vincent’s Hospital
Department of Addiction Medicine
• “Department of Drug & Alcohol Services” was established in 1964 through the
efforts of Professor Carl de Gruchy, Sister Christina Welsford and Dr Jim Rankin
• Initially founded as a “Special Clinic”
• Later expanded by Professor Greg Whelan to cover illicit drugs
• Increased services under Dr Joe Santamaria under the name “Department of
Community Medicine”
• In January 1988, Depaul House, the 12-bed non-medical, community
withdrawal unit was opened.
Department of Addiction Medicine
Current services
• Residential withdrawal service
• Inpatient consultation liaison service
• Ambulatory medical & counselling service
• Forensic counselling service
• Drink-drive program
• Education, training & research services
DoH “Better Responses to AOD Presentations
in Victorian EDs”
2013 analysis of ED attendances identified that
• 7.6% had AOD as a factor in their presentation (~3100/year = 8-9/day)
• 37% higher at weekends
Project implementation
• Extended coverage of specialist service
• Clarified the interface and pathways in the ED
• Implemented an AOD screening process
• Developed a method of measuring the impact on client outcomes
• Increased ED staff knowledge of AOD
#alcoholharmED
Alcohol Harm in EDs 2014 Survey
Dr Diana Egerton-Warburton
Emergency Physician & Lead Researcher,
Alcohol Harm in EDs Project
Project background
•
ACEM has received funding from the Australian Government for a two-year
project to quantify alcohol-related harm presenting to emergency departments
in Australia and New Zealand
•
EDs are not required to systematically screen and submit alcohol prevalence data
for state/territory/national patient data sets
•
Alcohol-related presentations to EDs are underestimated and data is incomplete.
Alcohol Harm in EDs
• Collect bi-national prospective data of alcohol harm presenting to EDs in
Australia and New Zealand
• Lead an informed community discussion about the harms related to alcohol use
and its impact on EDs
• Provide an evidence base to advocate for government policy change.
Alcohol Harm in EDs: “Snapshots”
• A point-prevalence survey was conducted in 106 EDs in Australia and New
Zealand at 2am on 14 December 2013
• Snapshot of the number of direct and indirect alcohol-related presentations in
the waiting room, ED and short stay or observation units
• Results:
• 14% of presentations in Australia were alcohol-related
• 18% in New Zealand were alcohol-related
• All regions had EDs with 1 in 3 alcohol-affected patients.
• Media campaign:
• AMA, NAAA, PHAA
• > 8 million audience.
• The survey will be repeated in December 2014.
Alcohol Harm in ED: 24/7 Survey
• A seven-day survey of alcohol-related presentations in December 2014
• Nine EDs in Australia and New Zealand
• Will generate a rich data set:
• Direct and indirect harm
• Percentage of alcohol-related presentations over a one-week period
• The range of alcohol-related presentations
• Demographics of alcohol-affected patients
• Flow on effects to the ED
• Drinking patterns prior to ED presentation
• AUDIT scores
• Validate snapshot survey methodology.
Alcohol SBIRT in Emergency Departments
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ACEM funded literature review underway
Recent Australian research suggest feasible and effective with resources
High rate of harm and risky drinking but low dependency
Teachable moment
Impact is product of reach x efficiency
• 5.7 million adults and adolescents present annually to Australasian EDs
• 10% alcohol harm and 45% hazardous drinking
• Potential audience of about 2.5 million
• Screen alone may be enough of a ‘Brief Intervention’
‘Although BI heads the list of effective and cost–effective
evidence based treatment methods, commonly less than 10% of
the population at risk of becoming hazardous and harmful
drinkers are identified and less than 5% of those who could
benefit are offered brief advice.’ (WHO, 2009).
Clinician Survey 2014
• Over 2000 emergency doctors and nurses were surveyed on their perceptions of
alcohol-related presentations in their ED in June 2014
• Largest survey of its kind to be undertaken in Australia and New Zealand
• At this event, we are releasing statistics on:
• The levels of verbal and physical aggression experienced by staff
• The effect of alcohol-related presentations on other patients in the ED
• Clinicians were also asked about:
• The functioning of the ED
• Staff job satisfaction and wellness
• Screening and brief interventions
• Training to deal with alcohol-affected patients
• We’ll be releasing more data in 2015.
Alcohol Harm in EDs 2014 Survey Findings
98%
of respondents had experienced alcohol-related
verbal aggression from patients in the last 12 months.
“I have been verbally threatened and told that they would be 'waiting for
me in the car park when I went home’.”
Alcohol Harm in EDs 2014 Survey Findings
92%
had experienced alcohol-related physical violence
or threats from patients in the last 12 months.
“One or two people are removed for physical aggression each shift, a staff
member is injured severely enough to have days off every few months,
patients are restrained by security every few hours. There is serious
property damage every one or two months.”
Alcohol Harm in EDs 2014 Survey Findings
87%
said they had felt unsafe due to the presence of an
alcohol-affected patient while working in their ED.
“It is one of the things most likely to drive me away from
Emergency Medicine.”
Alcohol Harm in EDs 2014 Survey Findings
Not surprisingly,
94%
said alcohol-related presentations in the ED had a
negative or very negative effect on the workload of ED staff.
“They are a serious burden because they take up a lot of time and
space without much therapeutic benefit.”
Alcohol Harm in EDs 2014 Survey Findings
88%
said that the care of other patients was negatively
or very negatively affected.
“Other patients have longer waiting times. They can feel threatened and
intimidated in an environment where they should feel safe. They are often
shocked and offended by what they see or hear.”
Alcohol Harm in EDs 2014 Survey Findings
“We as a specialty have come to accept abuse that no other public
service would tolerate.”
“If I am out of uniform I do not have to tolerate these behaviours
and have a course of action; if I am in uniform I am fair game!”
“Other patients in the waiting room have been assaulted. Many
patients become extremely fearful. Some leave the ED and miss
out on needed treatment.”
Video Presentation
#alcoholharmED
The reality of alcohol in the ED
Lisa Cox
Victorian Branch Treasurer, College
of Emergency Nursing Australasia (CENA)
#alcoholharmED
The reality of alcohol in the ED for
doctors: an AMA perspective
Dr Stephen Parnis
Emergency Physician & Vice-President,
Australian Medical Association
AMA National Alcohol Summit
AMA National Alcohol Summit
• National leadership on the supply of and
access to alcohol
• Public education campaigns about unsafe
drinking and alcohol harms
• Targeted alcohol prevention and
treatment services
• Specific measures for Aboriginal and
Torres Strait Islander people
• Regulation of alcohol marketing and
promotion
• Research and evaluation and data
collection to monitor and measure
alcohol use and alcohol-related harm
• A review of alcohol taxation and
pricing arrangements
• Transparent policy development
independent of industry influence
• www.ama.com.au/alcoholsummit
#alcoholharmED
ACEM’s alcohol policy
recommendations for Government
Dr Anthony Cross
Emergency Physician & President, ACEM
Alcohol policy recommendations
ACEM calls on governments in Australia and New Zealand to:
1. Introduce compulsory collection of alcohol-related ED presentation data
Add emergency department alcohol-related presentations to patient data sets
Mandatory collection of this data would provide:
• A clearer picture of the extent of alcohol-related presentations to hospital
• An evidence base to inform and evaluate policy decisions.
Alcohol policy recommendations
2. Introduce a preventative health program for emergency departments
Screening, brief intervention and referral for treatment (‘Brief Intervention’)
program for alcohol-affected patients in emergency departments
International research suggests that Brief Intervention can be an effective tool to
identify, reduce and prevent problematic use, abuse, and dependence on alcohol
and other drugs.
Alcohol policy recommendations
3. Address alcohol regulation and advertising
International evidence shows that when hours and days of sale are decreased,
consumption and harm decrease, and vice versa.
• Introduce 3am as the latest time for serving alcohol in pubs and clubs
• Maintain and extend the freeze on granting new late night licenses
• Introduce 10pm as the latest time for packaged liquor sales.
Alcohol policy recommendations
3. Address alcohol regulation and advertising
Control the advertising and promotion of alcohol, particularly to young people
• Young people are regularly exposed to advertisements depicting alcohol
consumption as social, fun and inexpensive
• We would like to see greater efforts made to protect young audiences up to 25
years from alcohol advertising, and the phasing out of alcohol sponsorship in
sports
• Alcohol advertising in Australia is self-regulated by the alcohol and advertising
industries. ACEM supports the establishment of an independent regulatory body
for alcohol advertising, sponsorship and promotions.
Alcohol policy recommendations
3. Address alcohol regulation and advertising
Tax alcohol products according to their alcohol content, not their price.
Alcohol products in Australia are taxed differently according to type, packaging,
alcohol content and cost. The greatest discrepancy in the current system is the wine
equalisation tax (WET). Wine is taxed according to its retail price rather than its
alcohol content, resulting in cheaper wines attracting far less tax. ACEM supports
measures to tax alcohol products according to their alcohol content.
Thank you
Get in contact:
Ange Wadsworth
Project Manager
[email protected]
Get more information:
www.acem.org.au
Join the conversation:
#alcoholharmED
Join us for lunch!