Barreras percibidas contra la implementación en los servicios de urgencias hospitalarios en España de un protocolo de cribado de consumo de alcohol e intervención breve en adolescentes

  1. María Falcón 1
  2. Javier Navarro-Zaragoza 1
  3. Rosa María García-Rodríguez 1
  4. Daniel Nova-López 2
  5. María Dulce González-Navarro 3
  6. María Mercadal 4
  7. Oscar García-Algar 4
  8. Aurelio Luna Ruiz-Cabello 1
  1. 1 Departamento de Ciencias Sociosanitarias, Medicina Legal y Forense, Universidad de Murcia
  2. 2 Hospital Virgen de la Arrixaca
    info

    Hospital Virgen de la Arrixaca

    Murcia, España

    ROR https://ror.org/058thx797

  3. 3 Hospital Virgen del Castillo, Yecla, Murcia
  4. 4 Universitat Autònoma de Barcelona
    info

    Universitat Autònoma de Barcelona

    Barcelona, España

    ROR https://ror.org/052g8jq94

Revista:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Any de publicació: 2018

Volum: 30

Número: 3

Pàgines: 189-196

Tipus: Article

DOI: 10.20882/ADICCIONES.1003 DIALNET GOOGLE SCHOLAR lock_openAccés obert editor

Altres publicacions en: Adicciones: Revista de socidrogalcohol

Resum

Background: Screening for alcohol consumption in adolescents is widely justified in the health care field because of the particular vulnerability of this population, which starts drinking alcohol at a very early age and frequently consumes high levels of the same. Hospital emergency departments (ED) could be a good venue to manage early detection and carry out brief intervention (BI) programmes. Objectives: The aim of this study was to identify perceived barriers for medical staff of three hospitals in Spain to successfully implement a protocol for alcohol detection and BI for minors in the ED. Methods: Exploratory qualitative analysis using focus groups with semistructured, flexible and open-ended questions to explore beliefs, attitudes, and barriers perceived by professionals to screening alcohol consumption and implementing BI in adolescents attended at the ED. Results: The main perceived barriers by health professionals were lack of time, work overload, mistrust, lack of validated and simple screening tools, lack of training/awareness and legal concerns about informed consent and confidentiality. Conclusions: Barriers to screening and intervention in ED are similar to those described previously. It is necessary to improve organization of time allocated for medical consultations, avoid limiting ED resources, motivate staff and provide appropriate training.

Informació de finançament

This work has been a part of a project financed by PNSD (2011-2013).

Finançadors

    • 2011-2013

Referències bibliogràfiques

  • Aristeiguieta, C. A. (2000). Screening patients for alcohol, tobacco, and other drug misuse: the role of brief interventions. Western Journal of Medicine, 172, 53–57.
  • Armitage, C. J., Rowe R., Arden M. A. y Harris P. R. (2014). A Brief Psychological Intervention That Reduces Adolescent Alcohol Consumption. Journal of Consulting and Clinic Psychology, 82, 546-550. doi:10.1037/a0035802.
  • Babor, T. (2003). Alcohol: no ordinary commodity. Oxford: Oxford University Press.
  • Beich, A., Gannik, D. y Malterud, K. (2002). Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. British Medical Journal, 325, 870–874.
  • Bradley, O., Boekeloo, M. S. y Novik, G. (2005). Clinical Approaches to Improving Alcohol Education and Counselling in Adolescents and Young Adults. Journal of Trauma, 59, S137-143.
  • Chen, C. Y., Storr, C. L. y Anthony, J. C. (2009). Early-onset drug use and risk for drug dependence problems. Addiction Behaviour, 34, 319-322. doi:10.1016/j.addbeh.2008.10.021.
  • Clark, D. B. y Moss, H. B. (2010). Providing alcohol-related screening and brief interventions to adolescents through health care systems: obstacles and solutions. Plos Medicine, 7, e1000214. doi:10.1371/journal.pmed.1000214.
  • Committee on Substance Abuse, (2011). Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics, 128, e1330-1340. doi:10.1542/peds.2011-1754.
  • Cunningham, R. M., Bernstein, S. L., Walton, M., Broderick, K., Vaca, F. E., Woolard, R.,… D’Onofrio, G. (2009). Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Academic Emergency Medicine, 16, 1078-1088. doi:10.1111/j.1553-2712.2009.00552.x.
  • Danielson, P. E., Rivara, F. P., Gentilello, L. M. y Maier, R. V. (1999). Reasons why trauma surgeons fail to screen for alcohol problems. Archives of Surgery, 134, 564-568.
  • Delaney-Black, V., Chiodo, L. M., Hannigan, J. H., Greenwald, M. K., Janisse, J. Patterson, G.,… Sokol, R. J. (2010). Just say “I don’t”: lack of concordance between teen report and biological measures of drug use. Pediatrics, 126, 887-893. doi:10.1542/peds.2009-3059.
  • Elliot, B. A. y Larson, J. T. (2004). Adolescents in midsized and rural communities: foregone care, perceived barriers, and risk factors. Journal of Adolescent Health, 35, 303–309. doi:10.1016/j.jadohealth.2003.09.015.
  • García Carretero, M. A., Novalbos Ruiz, J. P., Martínez Delgado, J. M. y O’Ferrall González, C. (2016). Validation of the Alcohol Use Disorders Identification Test in university students: AUDIT and AUDIT-c. Adicciones, 28, 194-204. doi:10.20882/adicciones.775.
  • Glaser B. G. y Strauss A. L. (1967). The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine.
  • Gonzálvez, M. T., Espada, J. P., Guillén-Riquelme, A., Secades, R. y Orgilés, M. (2016). Association between personality traits and substance use in Spanish adolescents. Adicciones, 28, 108-115. doi:10.20882/adicciones.777.
  • Gordon, A. J., Ettaro, L., Rodriguez, K. L., Mocik, J. y Clark, D. B. (2011). Provider, patient, and family perspectives of adolescent alcohol use and treatment in rural settings. The Journal of Rural Health, 27, 81–90. doi:10.1111/ j.1748-0361.2010.00321.x.
  • Guerri, C. y Pascual, M. (2010). Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence. Alcohol, 44, 15-26. doi:10.1016/j.alcohol.2009.10.003.
  • Hidalgo Vicario, M. I. y Redondo Romero, A. (2007). Adolescentes y drogas. Un reto para los profesionales sanitarios. Evidencias en Pediatría, 3, 60.
  • Kaul, P. y Coupey, S. M. (2002). Clinical evaluation of substance abuse. Pediatric Review, 23, 85-94.
  • Kelleher, D. C., Renaud, E. J., Ehrlich, P. F. y Burd, R. S. (2013). Pediatric Trauma Society Guidelines Committee: Guidelines for alcohol screening in adolescent trauma patients: a report from the Pediatric Trauma Society Guidelines Committee. Journal of Trauma and Acute Care Surgery, 74, 671-682. doi:10.1097/TA.0b013e31827d5f80.
  • Kelly, T. M., Donovan, J. E., Chung, T., Bukstein, O. G. y Cornelius, J. R. (2009). Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C, CRAFFT, RAPS4-QF, FAST, RUFT-Cut, and DSM-IV 2-Item Scale. Addiction Behaviour, 34, 668-674. doi:10.1016/j. addbeh.2009.03.038.
  • Marcell, A. V., Halpern-Felsher, B., Coriell, M. y Millstein, S. G. (2002). Physicians’ attitudes and beliefs concerning alcohol abuse prevention in adolescents. American Journal of Preventive Medicine, 22, 49-55.
  • Matali, J. L., Pardo, M., Trenchs, V., Serrano, E., Gabaldón, S. y Luaces, C. (2009). Consumo de drogas en adolescentes. Dilema ético en el abordaje diagnóstico-terapéutico. Anales de Pediatría, 70, 386-390. doi:10.1016/j. anpedi.2008.12.006.
  • Mezquita, L., Stewart S. H., Kuntsche, E. y Grant, V. V. (2016). Cross-cultural examination of the five-factor model of drinking motives in Spanish and Canadian undergraduates. Adicciones, 28, 215-220. doi:10.20882/ adicciones.822.
  • Miller, J. W., Naimi, T. S., Brewer, R. D. y Jones, S. E. (2007). Binge drinking and associated health risk behaviors among high school students. Pediatrics, 119, 76-85.
  • Millstein, S. G. y Marcell, A. V. (2003). Screening and counseling for adolescent alcohol use among primary care physicians in the United States. Pediatrics, 111, 114-122.
  • Mitchell, S. G., Gryczynski, J., O’Grady, K. E. y Schwartz, R. P. (2013). SBIRT for adolescent drug and alcohol use: Current status and future directions. Journal of Substance Abuse Treatment, 44(5), 463-472. doi:10.1016/j. jsat.2012.11.005.
  • Monti, P. M., Colby, S. M., Barnett, N. P., Spirito, A., Rohsenow, D. J., Myers, M., Woolard, R. y Lewander, W. (1999). Brief intervention for harm reduction with alcohol positive older adolescents in a hospital emergency department. Journal of Consulting and Clinical Psychology, 67, 989–994.
  • Monk, R. L. y Heim, D. (2016). Alcohol-related expectancies in adults and adolescents: similarities and disparities. Adicciones, 28, 35-40. doi:10.20882/adicciones.788.
  • Morini, L., Politi, L. y Polettini, A. (2009). Ethyl glucuronide in hair. A sensitive and specific marker of chronic heavy drinking. Addiction, 104, 915-920. doi:10.1111/ j.1360-0443.2009.02535.x.
  • Newton, A. S., Gokiert, R., Mabood, N., Ata, N., Dong, K., Ali, S.,… Wild, T. C. (2011). Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review. Pediatrics, 128, e180-192. doi:10.1542/peds.2010-3727.
  • Ozer, E. M., Adams, S. H., Orrell-Valente, J. K., Wibbelsman, C. J., Lustig, J. L., Millstein, S. G.,… Irwin, C. E. (2011). Does delivering preventive services in Primary Care reduce adolescent risky behavior? Journal of Adolescent Health, 49, 476-482. doi:10.1016/j.jadohealth.2011.02.011.
  • Plan Nacional sobre Drogas. (2009). Estrategia Nacional sobre Drogas 2009-2016. Madrid, España: Delegación del Gobierno para el Plan Nacional sobre Drogas, Ministerio de Sanidad, Servicios Sociales e Igualdad.
  • Plan Nacional sobre Drogas. (2010). Encuesta estatal sobre uso de drogas en estudiantes de secundaria (ESTUDES). Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad. Recuperado de http://www.pnsd.msc.es/Categoria2/observa/pdf/ESTUDES_2010.pdf.
  • Platt, L., Meléndez-Torres, G. J., O’Donnell, A., Bradley, J., Newbury-Birch, D., Kaner, E. y Ashton, C. (2016). How effective are brief interventions in reducing alcohol consumption: do the setting practitioner group and content matter? Findings from a systematic review and metaregression analysis. BMJ Open, 6,: e011473. doi:10.1136/ bmjopen-2016-011473.
  • Rutherford, H. J., Mayes, L. C. y Potenza, M. N. (2010). Neurobiology of adolescent substance use disorders: implications for prevention and treatment. Child and Adolescent Psychiatric Clinics of North America, 19, 479-492. doi:10.1016/j.chc.2010.03.003.
  • Schermer, C. R., Gentilello, L. M., Hoyt, D. B., Moore, E. B., Moore, J. B., Rozycki, G. S. y Feliciando, D. V. (2003). National survey of trauma surgeons’ use of alcohol screening and brief intervention. Journal of Trauma, 55, 849–856.
  • Tiburcio Sainz, M., Rosete-Mohedano, G., Natera Rey, G., Martínez Vélez, N. A., Carreño García, S. y Pérez Cisneros, D. (2016). Validity and reliability of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in university students. Adicciones, 28, 19-27. doi:10.20882/adicciones.786.
  • Van Hook, S., Harris, S. K., Brooks, T., Carey, P., Kossack, R., Kulig, J. y Knight, J. R. (2007). New England Partnership for Substance Abuse Research: The “Six T’s”: barriers to screening teens for substance abuse in primary care. Journal of Adolescent Health, 40, 456-461.