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Larry M. Gentilello, MD, FACS, Division of Burns, Trauma, Critical Care, UT Southwestern Medical School, Parkland Memorial Hospital, Dallas, TX 77477, 770.488-4142, DHungerford@cdc.gov
Between 35-50% of patients admitted to trauma centers are under the influence of alcohol. Alcohol use disorders play such a major role in causing injuries that efforts to prevent injury recurrence are unlikely to be successful if they remain untreated. In one randomized, prospective clinical trial, 46% of patients screened positive, and were randomized to a 30-minute brief intervention, or usual care. There was a significant reduction in alcohol intake and a 47% reduction in hospital readmission in the intervention group at three-year follow-up. A number of expert and federal consensus panels recommend routine screening an intervention in trauma centers, but this preventive strategy has not been widely adopted. In 1947, most states (42) adopted the Uniform Accident and Sickness Policy Provision Law (UPPL). The UPPL allows insurers to deny payment for treatment of injuries that occur while a patient is under the influence of alcohol or drugs. A recent survey demonstrated that the threat of non-reimbursement is a more important deterrent to alcohol screening than concerns about cost, time, or patient confidentiality. Trauma centers are unlikely to screen for alcohol if insurers may use this information to refuse to pay them. However, if alcohol use is not documented, insurers have no basis to deny payment. Thus, insurers currently pay for treatment of alcohol related injuries. It appears that UPPL repeal is required for widespread implementation of alcohol screening in trauma centers.
Learning Objectives:
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: University employee