Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Annually eight million emergency department (ED) visits are attributable to alcoholuse. Screening ED patients for at-risk alcohol and substance use is an integral component ofscreening, brief intervention, and referral to treatment programs, shown to be effective at reducingsubstance use. The objective is to evaluate ED patients’ acceptance of and willingness to disclosealcohol/substance use via a computer kiosk versus an in-person interview.

Methods: This was a cross-sectional, survey-based study. Eligible participants included thosewho presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable andable to consent. Patients had the opportunity to access the kiosk in the ED waiting room, andwere approached for an in-person survey by a research assistant (9am-5pm weekdays). Bothsurveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics andpreferences were calculated using chi-square tests and McNemar’s test.

Results: A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 byboth in person and kiosk. Single-modality participants were more likely to disclose hazardousdrinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participantswho had participated in screening via both modalities were more likely to reveal high-risk drug useon the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference foran in-person survey, which patients rated higher on privacy and comfort.

Conclusion: ED patients were significantly more likely to disclose at-risk alcohol and substance use toa computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening,despite reduced disclosure to a human screener. [West J Emerg Med. 2015;16(2):220–228.]