Of 22,923 patients screened for alcohol and other drug problems during December 1999 through December 2004, 10,255 (45%) reported using alcohol. Among the 5,243 patients who exceeded low-risk criteria set by the NIAAA, 43% (2,258) met the NIAAA criteria for at-risk or hazardous drinking or reported no more than one of the CAGE criteria. A total of 58% (3,085) were dependent on alcohol, based on meeting two or more CAGE criteria. About 15% of all the patients who were screened reported illicit drug use.
The HPAs performed brief interventions for 7,196 patients and referred 3,571 patients to specialized treatment facilities, mostly for problems with alcohol (59%), but also for drugs (28%) or both (13%).
At 1 month after presentation to the ED, the investigators were able to account for 74% of the referred patients either by talking with the patient directly on the phone or by calling the referred treatment facility. Of those who were contacted, 87% enrolled in a treatment program. Even if none of the patients who were not contacted enrolled in a treatment center, 64% of referred patients still enrolled in a treatment facility.
The Boston Medical Center ED, which originally started Project ASSERT as a demonstration project in 1993, runs a program similar to the one at Yale-New Haven. Several other hospitals around the country are trying to develop programs modeled after Project ASSERT.
One program is in its beginning stages at the Hospital of Saint Raphael, New Haven. So far the program has had some difficulty gaining support from ED staff at Saint Raphael, said Dr. Degutis. Unlike the HPAs at Yale-New Haven, the HPAs at Saint Raphael are not part of the ED staff. They are instead hired by the department of psychiatry at the hospital.
These HPAs have name badges with “psychiatry” printed on them, which “may change the way that the patient views them” when they go to ask a set of screening questions, Dr. Degutis explained. HPAs at Yale-New Haven have name badges printed with “Project ASSERT,” so that they can tell patients that they are part of a screening project to look for health risks.