Next, he conducted a randomized, controlled trial of 762 patients at Harborview Medical Center in Seattle. At one year of followup, the group that was randomly assigned to meet with an alcohol counselor while they were in the trauma center decreased their alcohol consumption by 22 drinks a week, compared to no change in those who were not offered counseling. In addition, the patients were followed for three years after discharge from the trauma center. During that time there was a 47 percent reduction in hospital readmission for trauma, and a 48 percent reduction in injury-related emergency department visits for the intervention group, compared with the control group.

Next, Gentilello conducted a nationwide survey of trauma surgeons to determine current attitudes toward screening and interventions. While more than 80 percent had no prior training in detection of alcohol problems, nearly all were willing to take time from their practice to learn these skills if the provision of counseling was shown to be feasible. The surgeons repeatedly asserted, however, that documentation of alcohol or drug use in patients' charts was not feasible because it would lead to insurance claim denials. In fact, even patients who did not have an alcohol problem and drank responsibly but were nevertheless injured (through no fault of their own) would be stuck with a potentially large and devastating medical bill.

Gentilello's group next conducted a nationwide survey of state insurance commissioners, which documented that 42 states had adopted legislation allowing insurers to deny payment for treatment of alcohol related injuries. They discovered the statute was identically
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Contact: Jerry Berger
jberger@caregroup.harvard.edu
617-667-7308
Beth Israel Deaconess Medical Center
17-Oct-2002