Brief Physician- and Nurse Practitioner–Delivered Counseling for High-Risk Drinkers

Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 11/1999; 159(18):2198-205. DOI: 10.1001/archinte.159.18.2198
Source: PubMed


There is a need for primary care providers to have brief effective methods to intervene with high-risk drinkers during a regular outpatient visit.
To determine whether brief physician- and nurse practitioner-delivered counseling intervention is efficacious as part of routine primary care in reducing alcohol consumption by high-risk drinkers.
Academic medical center-affiliated primary care practice sites were randomized to special intervention or to usual care. From a screened population of 9772 patients seeking routine medical care with their primary care providers, 530 high-risk drinkers were entered into the study. Special intervention included training providers in a brief (5- to 10-minute) patient-centered counseling intervention, and an office support system that screened patients, cued providers to intervene, and made patient education materials available. The primary outcome measures were change in alcohol use from baseline to 6 months as measured by weekly alcohol consumption and frequency of binge drinking episodes.
Participants in the special intervention and usual care groups were similar on important background variables and potential confounders except that special intervention participants had significantly higher baseline levels of alcohol usage (P = .01). At 6-month follow-up, in the 91% of the cohort who provided follow-up information, alcohol consumption was significantly reduced when adjusted for age, sex, and baseline alcohol usage (special intervention, -5.8 drinks per week; usual care, -3.4 drinks per week; P = .001).
This study provides evidence that screening and very brief (5- to 10-minute) advice and counseling delivered by a physician or nurse practitioner as part of routine primary care significantly reduces alcohol consumption by high-risk drinkers.

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    • "RCTs based on behaviorally defined interviewing methods have focused on indirect measures of the method's effect including: patient satisfaction [6] [7] [8] [9] [10], use of health services [9] [11], health status outcomes [12] [13] [14] [15] [16] [17], and quality of life metrics [16] [18]. While these measures demonstrate validity, they do not represent the direct effects of a given method on the provider–patient interaction (PPI). "
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    ABSTRACT: To evaluate interactional effects of patient-centered interviewing (PCI) compared to isolated clinician-centered interviewing (CCI). We conducted a pilot study comparing PCI (N=4) to CCI (N=4) for simulated new-patient visits. We rated interviews independently and measured patient satisfaction with the interaction via a validated questionnaire. We conducted interactional sociolinguistic analysis on the interviews and compared across three levels of analysis: turn, topic, and interaction. We found significant differences between PCI and CCI in physician responses to patients' psychosocial cues and concerns. The number and type of physician questions also differed significantly across PCI and CCI sets. Qualitatively, we noted several indicators of physician-patient attunement in the PCI interviews that were not present in the CCI interviews. They spanned diverse aspects of physician and patient speech, suggesting interactional accommodation on the part of both participants. This small pilot study highlights a variety of interactional variables that may underlie the effects associated with patient-centered interviewing (e.g., positive relationships, health outcomes). Question form, phonological accommodation processes, and use of stylistic markers are relatively unexplored in controlled studies of physician-patient interaction. This study characterizes several interactional variables for larger scale studies and contributes to models of patient-centeredness in practice.
    Patient Education and Counseling 07/2012; 88(3):373-80. DOI:10.1016/j.pec.2012.06.005 · 2.20 Impact Factor
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    • "ek ↓4 . 1 , BL 13 . 6 , F / U 9 . 5 - 0 . 30 * Maisto et al . 2001 [ 58 ] n = 85 primary care High - risk and dependent drinkers ( AUDIT Ն8 ) Usual care 7 BL x 2 , 1 , 3 , 6 , 9 , 12 months 5 Q / F screen dependence screen drinking diary consequences readiness At 12 months : mean # drinks per drinking day ↓1 . 5 , BL 6 . 0 , F / U 4 . 5 - 0 . 25 * Ockene et al . 1999 [ 59 ] n = 233 primary care >NIAAA low - risk criteria ; dependency not excluded , but only 2% of sample Discharged with booklet and written advice on general health n = 2 BL , 6 n = 5 Q / F screen drinking diary dependency screen consequences treatment history At 6 months : mean drinks per week ↓3 . 1 , BL 16 . 4 ( 12 . 1 ) , F / U 13 "
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    ABSTRACT: Reductions in control group consumption over time that are possibly related to research design affect the impact of brief alcohol interventions (BAI) in clinical settings. We conducted a systematic review to identify research design factors that may contribute to control group change, strategies to limit these effects and implications for researchers. Studies with control group n > 30 were selected if they published baseline and outcome consumption data, conducted trials in clinical settings in Anglophone countries and did not censor gender or age. Among 38 studies cited in 20 reviews through October 2009, 16 met criteria (n = 31-370). In 54%, controls received alcohol specific handouts, advice and/or referral. Both the number and depth of assessments were highly variable. The percentage change in consumption ranged from-0.10 to-0.84 (mean-0.32), and effect size from 0.04 to 0.70 (mean 0.37). Published data were insufficient for meta-analysis. Researchers should consider strategies to reduce the impact of research design factors, such as procedures to enhance sample diversity, blind subjects to study purpose to limit social desirability bias, reduce the number and depth of instruments (assessment reactivity), and finally, analytic techniques to decrease the impact of outliers and regression to the mean. This review identifies problems with retrospective analysis of predictors of control group change, and underscores the need to design prospective studies to permit identification, quantification and adjustment for potential sources of bias in BAI trials.
    Drug and Alcohol Review 09/2010; 29(5):498-507. DOI:10.1111/j.1465-3362.2010.00174.x · 1.55 Impact Factor
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    • "Many clinical trials of brief alcohol intervention have demonstrated short-term reductions in alcohol use.17–20 A Cochrane review found that brief intervention has been effective in primary care settings in lowering alcohol consumption.21 "
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    ABSTRACT: Alcohol screening and brief intervention for unhealthy alcohol use has not been consistently delivered in primary care as part of preventive healthcare. To explore whether telephone-based intervention delivered by a health educator is efficacious in reducing at-risk drinking among older adults in primary care settings. Secondary analyses of data from a randomized controlled trial. Subjects randomized to the intervention arm of the trial (n = 310). Personalized risk reports, advice from physicians, booklet about alcohol and aging, and up to three telephone calls from a health educator. All interventions were completed before the three-month follow-up. Risk outcomes (at-risk or not at-risk) at 3 and 12 months after enrollment. In univariate analyses, compared to those who remained at risk, those who achieved not at-risk outcome at 3 months were more likely to be women, Hispanic or non-white, have lower levels of education, consume less alcohol, drink less frequently, and have lower baseline number of risks. In mixed-effects logistic regression models, completing all three health educator calls increased the odds of achieving not at-risk outcome compared to not completing any calls at 3 months (OR 5.31; 95% CI 1.92-14.7; p = 0.001), but not at 12 months (OR 2.01; 95% CI 0.71-5.67; p = 0.18). Telephone-based intervention delivered by a health educator was moderately efficacious in reducing at-risk drinking at 3 months after enrollment among older adults receiving a multi-faceted intervention in primary care settings; however, the effect was not sustained at 12 months.
    Journal of General Internal Medicine 04/2010; 25(4):334-9. DOI:10.1007/s11606-009-1223-2 · 3.42 Impact Factor
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