Local Implementation of Alcohol Screening and Brief Intervention at Five Veterans Health Administration Primary Care Clinics: Perspectives of Clinical and Administrative Staff

Williams, Emily C.; Achtmeyer, Carol E.; Young, J. P.; Rittmueller, Stacey E.; Ludman, Evette; Lapham, Gwen T.; Lee, Amy K.; Chavez, Laura J.; Berger, Douglas; Bradley, Katharine A.

doi:10.1016/j.jsat.2015.07.011

Cited by 53 publications

(70 citation statements)

References 62 publications

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“…Finally, this study evaluated associations between gender and receipt of brief intervention and does not address the quality of brief interventions received. Because other studies have identified quality concerns with brief interventions delivered clinically in VA (Williams et al, 2016; Williams et al, 2014), the clinical significance of this study’s findings may be limited.…”

Section: Discussionmentioning

confidence: 98%

“…These elements of brief intervention are consistent with those offered in randomized controlled trials of its efficacy (Whitlock, Polen, Green, Orleans, & Klein, 2004), and documentation of these elements is required to meet VA’s performance measure(Williams et al, 2014) and often facilitated with electronic clinical decision support (Williams et al, 2016). Gender was based on administrative documentation of male or female sex.…”

Section: Methodsmentioning

confidence: 99%

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Influence of a targeted performance measure for brief intervention on gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the Veterans Health Administration

Williams

Lapham

Rubinsky

et al. 2017

Journal of Substance Abuse Treatment

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Aims Women are less likely than men to receive brief intervention (BI) for unhealthy alcohol use. In 2007, the U.S. Veterans Health Administration (VA) used a national performance measure to implement BI. Although AUDIT-C scores ≥3 for women and ≥4 for men optimize sensitivity and specificity for identifying unhealthy alcohol use, VA’s performance measure required BI only among a targeted subgroup defined by a non-gender-specific score threshold (AUDIT-C≥5). This may have influenced gender differences in receipt of BI among those optimally eligible for BI. Therefore, we evaluate differences in proportions of women and men offered BI before and after BI implementation. Methods National secondary chart review data (7/06-6/10) identified all outpatients with unhealthy alcohol use for whom BI would be indicated (AUDIT-C ≥3 women, ≥4 men). Logistic regression, including a time-by-gender interaction, estimated the prevalence and 95% confidence interval (CI) of BI for women and men pre- and post-implementation. Findings Among patients optimally eligible for BI (n=51,272, 8,206 women and 43,066 men), the prevalence of BI increased more steeply for men than women after implementation (interaction p-value <0.0001). Pre-implementation rates of BI were 21% (95% CI, 18-24) for women and 26% (95% CI, 24-29) for men, and post-implementation rates were 32% (95% CI, 30-34) for women and 47% (95% CI, 45-49) for men. Conclusions Healthcare systems implementing BI with performance measures may wish to consider that specifying a single alcohol screening threshold for men and women may increase gender differences in receipt of BI among patients likely to benefit.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Influence of a targeted performance measure for brief intervention on gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the Veterans Health Administration

Williams

Lapham

Rubinsky

et al. 2017

Journal of Substance Abuse Treatment

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“…Such strategies are increasingly important for improving the quality of care and are central to the practice of medicine, but their effectiveness is under-studied. Although some qualitative evidence from a single VA region suggests that the VA's system-level approaches to brief intervention implementation may have contributed to a culture of checking boxes (Williams et al, 2016), the results of the present national study suggest some positive changes in patient-reported receipt of recommended alcohol-related advice.…”

Section: Discussionmentioning

confidence: 53%

“…Each VA facility was free to implement brief interventions as they chose and, although core components of the performance measure were required at all sites, electronic clinical reminders could be modified locally. Clinician training for conducting brief interventions was largely left to individual clinics (Williams et al, 2016).…”

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confidence: 99%

Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions

Chavez

Williams

Lapham

et al. 2016

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. Method: This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP;-2011 who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C 5) was estimated for each year. Results: Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. Conclusions: The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation. (J. Stud. Alcohol Drugs, 77, 500-508, 2016)

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“…Facilitators and barriers may need to be considered when implementing brief interventions in order to create circumstances that maximise their effectiveness. For example, a lack of understanding by individuals and organisations of the goals of brief interventions has been described as a barrier to their successful implementation,25 47 so that for maximum effectiveness of brief interventions training may be important.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the effectiveness of alcohol brief interventions for the UK military personnel moving back to civilian life

et al. 2017

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Local Implementation of Alcohol Screening and Brief Intervention at Five Veterans Health Administration Primary Care Clinics: Perspectives of Clinical and Administrative Staff

Cited by 53 publications

References 62 publications

Influence of a targeted performance measure for brief intervention on gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the Veterans Health Administration

Influence of a targeted performance measure for brief intervention on gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the Veterans Health Administration

Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions

A systematic review of the effectiveness of alcohol brief interventions for the UK military personnel moving back to civilian life

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