Treatment of Adolescent Alcohol Misuse and Clinician Acceptance of Technology-facilitated Care in the Emergency Department

Abstract: Screening, brief intervention, and referral to treatment (SBIRT) is the recommended approach for clinicians to use with adolescent patients with suspected alcohol-related problems. Although the emergency department (ED) is an opportune setting for early identification of alcohol misuse, SBIRT is underused. Use of technology to facilitate the delivery of SBIRT is regarded as a promising strategy to standardize, expedite, and support delivery of care. However, little is known about its implementation in real-world clinical practice. The aim of this research was to explore the acceptance of technology-facilitated care in the ED, particularly, for the treatment of adolescent patients with problematic alcohol use. This thesis includes a scoping review (Study 1) and survey (Study 2). Study 1 was guided by the Arksey and O’Malley scoping review framework and examined emergency clinicians’ acceptance of cognitive support technology used at the point-of-care (POC) in the ED. This review demonstrated that while health care providers are receptive to technology-facilitated care in the ED, gaps remain between provider intentions and practice. Study 2 was a cross-sectional survey of pediatric emergency physicians from across Canada. A 35-item questionnaire was developed to examine physicians’ perceptions of adolescent alcohol drinking and treatment for alcohol misuse, current SBIRT practices, and acceptance of technology-based SBIRT. Survey findings revealed that physicians recognize the need and responsibility to address adolescent alcohol misuse. However, confidence in knowledge and abilities for SBIRT execution was low. While physicians were receptive to using technology to deliver SBIRT, they were unsure about its impact on patient care. Taken together, findings from both studies suggest that to promote integrated technology-facilitated patient care, strategies to support and orient clinicians when using technology are needed.