Implementation of tailored interventions to treat harmful alcohol and drug use in Norwegian hospitals and municipality services (AlcoTail)

Estimates show that about 250,000 admitted patients to Norwegian hospitals have moderate alcohol intake, of which 10,000 have severe intake. High alcohol consumption is one of the main causes of mortality and morbidity and is a significant contributor to the total health costs. By asking patients about their alcohol use and informing about the harmful effects of alcohol, we want to reduce their use of alcohol and improve their health. In the AlcoTail project, we will introduce four standardized questions that map alcohol use and blood tests that measure use of alcohol and psychoactive medicinal drugs in medical patients who are admitted to hospital. We will first follow patients who receive regular follow-up. Then we will introduce a new standardized information and referral practice, based on the answers to the standardized questions. Patients' alcohol use is indicated in green (low), yellow (risky) and red (harmful). Patients in the yellow and red categories will be referred according to a standardized scheme for follow-up in existing health services, mainly the primary health service. We will conduct follow-up studies to investigate possible changes in the use of alcohol, medicines and health care services, and compare patients who received regular follow-up with those who received new standardized follow-up. In this way, we will evaluate the effect of the new standardized measures, both for the patients and for the health care system. The interdisciplinary research team will use various research approaches, including an experimental design, qualitative interviews with health professionals and patients in both the primary and specialist health services. We will use data from national registers to study the effect of the intervention on the use of health services, including the health economy. The study will also describe and examine the course of treatment for drug-addicted people who receive municipal housing services.

Approximately 250,000 acutely hospitalized patients in Norway have high alcohol intake and 10,000 have very high intake. High alcohol use is among the leading causes of mortality and morbidity and a significant contributor to overall health care costs. Given the overlap between alcohol and psychoactive drug use in somatic diseases, and the generally low rates of identification and treatment of alcohol and drug misuse, implementing a brief screening-based intervention in somatic hospitals with tailored follow-up in primary care is considered an effective strategy for reducing deleterious health effects and reducing overall health care costs. Therefore, this project will implement screening routines to classify alcohol consumption as low, high or very high (based on self-report using AUDIT-4 and PEth as an objective biomarker). Patients with high/very high alcohol use will be referred to treatments in both the specialist service and in primary care. Among patients with a time-limited prescription for a psychoactive drug, drug concentrations in patient blood samples will also be measured. The analytical results will be interpreted by a clinical pharmacologist and the patient’s primary care physician will receive this information to evaluate compliance and determine whether prescriptions changes are necessary. Patients acutely admitted to a medical department are included. To address potential differences in impact based on socio-economic factors as well as adaptation to local context, the screening-intervention will be implemented in hospitals in central urban areas as well as rural areas. The interdisciplinary research team will use a mixed methods design including an experimental component, qualitative interviews with health professionals and patients in both the primary and specialist care service. National registers will be used to study the impact of the intervention on health care utilization, and its impact on health economics will also be evaluated.