Brief Intervention for Heavy Drinking in Primary Care

Abstract

BACKGROUND Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized in spite of multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery. OBJECTIVE To determine the characteristics of PC patients who reported initiating BI with their providers, and to evaluate the association between initiator (patient vs. provider) and drinking following a BI. METHODS In the context of clinical trial, patients (N=267) who received BI during a PC visit reported on the manner in which the BI was initiated, readiness to change, demographics, and recent history of alcohol consumption. Drinking was assessed again at 6-months following the BI. RESULTS Fifty percent of patients receiving a BI reported initiating the discussion of drinking themselves. Compared with those who reported a provider-initiated discussion, self-initiators were significantly younger (43.7 vs. 47.1, p=.03), more likely to meet DSM criteria for current major depression (24% vs. 14%, p=.04), and more likely to report a history of alcohol withdrawal symptoms (68% vs. 52%, p<.01). Baseline readiness to change, baseline consumption rates, and current DSM-IV alcohol dependence were not different between groups. In the two-to-three weeks following BI, self-initiators reported greater decreases in drinks per week (5.7 vs. 2.4, p=.02), and drinking days per week (1.0 vs. 0.3, p=.002). At six month follow up, self-initiators showed significantly greater reductions in weekly drinking compared to those whose provider initiated the BI (p=.002). CONCLUSIONS Patient- and provider-initiated BI occurred with equal frequency, and patient-initiated BIs were associated with greater reductions in alcohol use. Future efforts to increase the BI rate in PC should include a focus on prompting patients to initiate alcohol-related discussions.

Public perceptions of how alcohol consumption is dealt with in Swedish and Norwegian health care

“…Findings from an American study showed that patients who initiated a BI themselves after being prompted to do so, decreased their alcohol consumption more than patients who received provider-initiated BI ( Rose et al, 2015 ). Given that more than half of the participants in our study agreed to a large or some extent that “Healthcare providers should ask about patients’ alcohol consumption, but only if the issue is brought up by the patient” it would be interesting to investigate such an approach in future research.…”

A Randomized Controlled Trial of IVR-Based Alcohol Brief Intervention to Promote Patient–Provider Communication in Primary Care

“…[5][6][7] In two of our previous studies, approximately half of patients interviewed after a primary care visit reported that they themselves had brought up the topic of alcohol for discussion. 8,9 With the dual objective of increasing patient-provider communication about alcohol and offering an automated pre-visit BI to patients who might not otherwise receive one, we developed a system for alcohol screening and BI using Interactive Voice Response (IVR). The IVR performs pre-visit screening to identify individuals with unhealthy alcohol consumption, 10 offers a BI to those who screen positive, and encourages them to discuss alcohol at the upcoming visit.…”