TRAINING PHYSICIANS ABOUT IMPAIRED DRIVING ISSUES

In 1997, the National Highway Traffic Safety Administration (NHTSA) awarded eight cooperative agreements to support the development of innovative programs that have the potential to substantially reduce alcohol-related fatalities. One of these grants was awarded to the Harborview Injury Prevention and Research Center in Seattle, Washington. The Harborview team has prepared a brief summary of the activities they conducted under the grant.

Alcoholism is the most common chronic disease in trauma patients, and one of the most common in patients treated in primary care. Studies have shown that brief counseling intervention in trauma centers is efficient in reducing drinking and its related illness and injury. Unfortunately, although trauma centers and primary care clinics are ideal settings for such brief alcohol interventions, routine screening and brief counseling for alcohol problems are not commonly practiced by physicians in these settings. The objective of the project was to address alcohol abuse at the individual patient level and at the community level.

At the individual patient level, the project encouraged physicians to perform a protocol for brief alcohol interventions to address alcohol abuse. This protocol consists of screening for alcohol problems, brief counseling, and referral. This was accomplished primarily by offering training to physicians, residents, and medical students.

At the community level, the project involved health professionals acting as advocates for strong DWI legislation and for coverage of care by health insurance plans.

Specifically, the goals of the project, which was conducted in the Pacific Northwest (Washington, Alaska, Montana, and Idaho) were to:

• Train medical students on the problems of impaired driving, methods to screen patients, techniques of brief alcohol intervention, and indications for referral of patients for more in-depth alcohol treatment.
• Train University of Washington residents on the problems of impaired driving, methods of screening, and brief interventions.
• Integrate training in substance abuse and brief counseling interventions into the University of Washington School of Medicine's curriculum.
• Integrate methods of alcohol screening, intervention, and referral in continuing medical education programs for primary care and other specialty physicians in the Pacific Northwest.
• Develop and disseminate user-friendly materials to promote and teach the brief intervention approach.
• Investigate barriers in the United States to implementing alcohol screening in hospital emergency departments.
• Work to establish alcohol screening and brief interventions as part of national practice guidelines for medical care.
• Disseminate the program nationally through professional organizations, national publications, and national presentations.

Conclusions

• Among the study's conclusions are:
• Training medical students and residents about alcohol screening and intervention is feasible and well-received, but obtaining training time is difficult.
• In order to institutionalize substance abuse training, champions (permanent faculty members who are committed to addressing and teaching substance abuse) are needed.
• Using a theme approach for training is best. Under this approach, substance abuse is seen not as a curriculum topic but as a common theme appearing throughout medical school, in all courses, and in all clinical settings.
• Many physicians show little interest in learning about brief interventions. If medical
• reimbursement patterns change, physicians maybe more likely to address alcohol problems with their patients.
• Physicians' concerns that screening for alcohol abuse may result in denial of coverage by insurance companies appear to be based in fact, as codified in the statutes of most states.

HOW TO ORDER

For a copy of Addressing Alcohol-Impaired Driving: Training Physicians to Detect and Counsel their Patients Who Drink Heavily (30 pages), write to the Office of Research and Traffic Records, NHTSA, NTS-31, 400 Seventh Street, S.W., Washington, DC 20590, fax (202) 366-7096, or download from http://www.nhtsa.dot.gov Jonathan Walker, Ph.D., and then Amy Berning were the contract managers for this project.

U.S. Department
of Transportation
National Highway
Traffic Safety
Administration
400 Seventh Street, S.W. NTS-31
Washington, DC 20590

Traffic Tech is a publication to disseminate information about traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as you wish. If you would like to receive a copy contact:
Linda Cosgrove, Ph.D., Editor, Evaluation Staff
Traffic Safety Programs
(202) 366-2759, fax (202) 366-7096
E-mail: lcosgrove@nhtsa.dot.gov