Intervención breve en accidentados con alcoholemia positiva desde un centro de traumatología
DOI:
https://doi.org/10.20882/adicciones.551Palabras clave:
lesionados de tráfico, centro de traumatología, formación, cribado de alcohol, intervención breveResumen
Objetivos: E1 objetivo principal de la investigación es comprobar la efectividad de la intervención breve para reducir el consumo de alcohol en accidentados de tráfico adultos con alcoholemia positiva y sin dependencia del alcohol. En objetivo de la etapa piloto es comprobar la viabilidad estructural del proyecto (capacitación de los profesionales y viabilidad del cribado e intervención desde un centro de traumatología, así como una estimación aproximada de la prevalencia y perfil de los lesionados de tráfico con presencia de alcohol. Material: Se elabora un programa de formación con material de apoyo. Se aplica un método de detección del alcohol en saliva en lesionados de tráfico que acuden a urgencias de traumatología. A los pacientes con saliva positiva se les ofrece una intervención breve. Se recoge la opinión del personal sobre la eficacia percibida y viabilidad estimada del proyecto gobal (cribado e intervención) mediante cuestionarios de opinión.. Se estudian la prevalencia y perfil de los pacientes con saliva positiva a partir del análisis comparativo de variables seleccionadas. Resultados: El personal entrenado considera (80%) útil y adecuada la formación recibida. Las enfermeras consideran (89%) que el método es fácil, no plantea demasiados problemas (55%) y es bien aceptado por el paciente (53%). El personal entrenado se ha sentido cómodo y eficiente (67%) al realizar la intervención. 261 de 264 pacientes aceptaron el cribado y el 11% tenía alcohol en saliva. Sólo 2 pacientes rechazaron la intervención, que fue practicada en 16 lesionados. Los pacientes con saliva positiva acuden más en fines de semana (p 0,005) y quedan ingresados con mayor frecuencia (p 0,05) que aquéllos con saliva negativa. Conclusión: el programa está bien estructurado, es viable y aceptado por el paciente. El estudio definitivo incluirá la determinación del alcohol en orina, en pacientes con saliva seca, y reforzará el cribado en fines de semana y politraumáticos.Citas
(1) Babor TF, Grant M (eds.) Programme on Substance Abuse. Project on identification and management of alcohol-related problems. Report on Phase II: a randomized clinical trial of brief intervention in primary health
care. Geneva , World Health Organization, 1992.
(2) Israel Y, Hollander O, Sánchez-Craig M, Booker S, Miller Vet al.: Screening for problem drinking and counseling by the primary care physician-nurse team. Alcoholism: Clinical & Experimental Research 1996; 20: 1443-1450.
(3) Richmond R, Heather N, Wodak A, Kehoe L, Webster I: Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction 1995; 90:119-132.
(4) Heather N: Brief Intervention Strategies. En Hester RK & Miller WR (eds.): Handbook of Alcoholism Treatment Approaches. Effective Alternatives. Boston, London Allyn & Bacon, 1995a (pp.: 105 –122)
(5) Deehan A, Templeton L, Taylor, Drummond C, Starng J. Are practice nurses an unexplored resource in the identification and management of alcohol misuse? Results from a study of practice nurses in England and Wales in 1995. J Adv Nurs 1998; 28: 592-597.
(6) Peters J, Brooker Ch, Mc Cabe C, Short N.: Problems encountered with opportunistic screening for alcoholrelated problems in patients attending an Accident and Emergency Department. Addiction 1998; 93 (4): 589-
(7) McIntosh MC, Leigh G, Baldwin NJ, Marmulak J. Reducing alcohol consumption. Comparing three brief methods in family practice. Can Fam Physician 1997; 43:1959-1962, 1965-1967.
(8) Ockene JK, Adams, A, Hurley TG, Wheeler EV, Hebert JR. Brief physician- and nurse practitioner- deliverd cunseling for high-risk drinkers: does it work? Arch Int Med 1999; 159: 2198-2205.
(9) Aalto M; Pekuri P; Seppä K: Primary health care nurses’ and physicians’ attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers. Addiction 2001; 96: 305-311.
(10) Ockene JK; Wheeler EV; Adams A, Hurley TG; Hebert J.: Provider training for patient-centered alcohol counseling in a primary care setting. Arch Inter Med. 1997; 157: 2334-2341.
(11) Kahan M, Wilson L, Becker L: Effectiveness of physician-based interventions with problem drinkers: a review. Can Med Assoc J 1995; 152: 851-859.
(12) Degutis, LC; Schriver, JA.: Emergency Department (ED) physician screening for potential alcohol related problems in patients with minor injuries: results from an urban ED. 4thWorld Conference Amsterdam on Injury Prevention and Control. RAI-Amsterdam17-20 May 1998.
(13) Shepherd,D; Hargarten S.: Alcohol screening in the emergency department: blood versus saliva study (abstract). Ann. Emerg Med. 1994; 23:612.
(14) Clifford PR, Sparadeo F, Minugh PA, Nirenberg TD, Woolard R, Longabaugh R, Becker B: Identification of hazardous /harmful drinking among subcretically injured patients. Acad Emerg Med 1996; 3(3): 239-245.
(15) Tu GC, Kapur B, Israel Y: Characteristics of new urine, serum and saliva alcohol reagent strip. Alc Clin Exp Res 1992; 16 (2): 222-227.
(16) Jones AW: Measuring ethanol in saliva wih the QED enzymatic test device: Comparison with blood- and breath- alcohol concentrations. J Anal Toxicol 1995;19:169-174.
(17) Bates ME, Martin CS: Immediate quantitative estimation of blood alcohol concentrations from saliva. J Stud Alc. 1997; 58 (5): 531-538.
(18) Phair IC, Mardel S, Bodiwala GG: Blood alcohol concentration measurement using a salivary reagent stick: a reliable tool for emergency departments? Arch Emerg Med 1990;7 (2): 69-72.
(19) Pate LA, Hamilton JD, Park RS, Strobel RM: Evaluation of a saliva alcohol test stick as a therapeutic adjunt in an alcoholism treatment program. J Stud Alc 1993; 54 (5): 520-521.
(20) Schwartz RH, Clark HW, Meek PS: Laboratory tests for rapid screening of drugs of abuse in the workplace: a review. J Addict Dis 1993; 12 (2): 43-56.
(21) Bien, Th.; Miller, W.R.; Tonigan, J.S.: Brief interventions for alcohol problems: a review. Addiction 1993; 88: 315-336.
(22) Wilk AI; Jensen NM; Havighurst TC: Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Int Med 1997; 12: 274-283.
(23) Chafetz ME, Blane HT, Abram HS, Golner J, Lacey E et al.: Establishing treatment relations with alcoholics. J Nerv Ment Dis 1962; 134: 395-409.
(24) Chafetz ME, Blane HT, Abram HS, Clark E, Golner JH et al. Establishing treatment relations with alcoholics: a supplementary report. J Nerv Ment Dis 1964; 138:390-393.
(25) D’Onofrio G, Bernstein E, Bernstein J, Woolard R, Brewer Ph A, Craig SA et al.: Patients with alcohol problems in the emergency department, part 2:Intervention and referral. Academic Emerg Med 1998; 5: 1210-1217.
(26) Bernstein E, Bernstein J, Levenson S: Project ASSERT: an ED based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann. Emerg Med 1997; 30: 181-189.
(27) Longabaugh R, Minugh PA, Nirenberg TD, Clifford PR, Becker B, Woolard R. Injury as a motivator to reduce drinking. Acad Emerg Med 1995; 2: 817-825.
(28) Gentinello LM, Duggan P, Drummond D et al.: Major injury as a unique opportunity to initiate treatment in the alcoholic. Am J Surg 1988; 156: 558-561.
(29) Antti-Poika I, Karaharju E, Roine R& Salaspuro M: Intervention of heavy drinking: a prospective and controlled study of 438 consecutive injured male patients. Alcohol &Alcoholism 1988; 23: 115-121.
(30) Gentinello, LM, Rivara FP, Donovan DM, Jurkovich GJ, Daranciang E et al.: Alcohol Interventions in a trauma center as a means of reducing the risk of injury recurrence. Ponencia al 119th Meeting of the American Surgical Association, San Diego, 1999.
(31) Sommers MS, Dyehouse JM, Howe SR, Lemmink J.: Preventing alcohol-related motor vehicle injury with brief intervenction strategies: preliminary findings with 60 subjects. 42nd Annual Proceedings. Association for the Advancement of Automotive Medicine. October 5-7, 1998. Charlottesville, Virginia.
(32) Sommers MS, Dyehouse JM, Howe SR, Weeks A, Russell AC: Using brief interventions following alcohol-related motor vehicle crashes to reduce drinking and further injury. Ponencia presentada en ICADTS-2000,
Estocolmo, 20-25 Mayo 2000.
(33) Jurkovich GJ; Rivara FP; Gurney, JG; Ries, R; Mueller, BA; Copass, M.: The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 1993; 270 (1): 51-56.
(34) Rivara, FP; Koepsell, TD; Jurkovich, GJ; Gurney, JG; Sodeberg, R.: The effects of alcohol abuse on readmission for trauma. JAMA 1993; 270 (16): 1962-1964.
(35) Rodríguez-Martos A: Medical education: the way ahead. WHO Ministerial Conference on Young People and Alcohol. Working Group 4: Health Systems and Alcohol. Stockholm, 19-21 February 2001.
(36) Alcohol On-Site. Assay for the Qualitative Detection of alcohol in urine and saliva. Roche Diagnostic Systems. Somerville, U.S. October 1996
(37) Colom J, Gual A. Un modelo de intervención integral sobre los problemas derivados del alcohol desde la atención primaria de salud: el programa Beveu Menys. JANO 2000 LIX: 93-96.
(38) Brooker Ch, Peters J, McCabe Ch, Short N: The views of nurses to the conduct of a randomised controlled trial of problem drinkers in an accident and emergency department. Int J Nursing Studies 1999; 36: 33-39.