Article

Interactive Voice Response Technology Can Deliver Alcohol Screening and Brief Intervention in Primary Care

The University of Vermont, Burlington, VT 05401, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 04/2010; 25(4):340-4. DOI: 10.1007/s11606-009-1233-0
Source: PubMed

ABSTRACT Alcohol screening and brief intervention (BI) is an effective primary care preventive service, but implementation rates are low. Automating BI using interactive voice response (IVR) may be an efficient way to expand patient access to needed information and advice.
To develop IVR-based BI and pilot test it for feasibility and acceptability.
Single-group pre-post feasibility study.
Primary care patients presenting for an office visit.
IVR-BI structured to correspond to the provider BI method recommended by NIAAA: (1) Ask about use; (2) Assess problems; (3) Advise and Assist for change, and (4) Follow up for continued support. Advice was tailored to patient readiness and preferences.
Utilization rate, call duration, and patients' subjective reports of usefulness, comfort and honesty with the IVR-BI. Pre-post evaluation of motivation to change and change in alcohol consumption as measured by Timeline Follow Back.
Call duration ranged from 3-7 minutes. Subjective reactions were generally positive or neutral. About 40% of subjects indicated IVR-BI had motivated them to change. About half of the patients had discussed drinking with their provider at the visit. These tended to be heavier drinkers with greater concerns about drinking. Patients who reported a provider-delivered BI and called the IVR-BI endorsed greater comfort and honesty with the IVR-BI. On average, a 25% reduction in alcohol use was reported two weeks after the clinic visit.
Using IVR technology to deliver BI in a primary care setting is feasible and data suggest potential for efficacy in a larger trial.

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    • "Whether they are applicable to settings with low computer literacy is debatable. Another technology that has been used in this context is interactive voice response (IVR) technology.68 This technology automates the screening and brief intervention and seems to have an impact on reducing drinking, although little is known about the sustainability of IVR-based interventions. "
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    ABSTRACT: Background The Patient Protection and Affordable Care Act of 2010 supports integration of substance abuse interventions and treatments into the mainstream health care system. Thus, effective screening and intervention for substance use disorders in health care settings is a priority. Objective This paper reviews the prevalence of alcohol and drug use disorders (abuse or dependence) in primary care settings and emergency departments, as well as current screening tools and brief interventions. Methods MEDLINE was searched using the following keywords: alcohol use, alcohol use disorder, drug use, drug use disorder, screening, primary care, and emergency departments. Using the related-articles link, additional articles were screened for inclusion. This review focuses on alcohol and drug use and related disorders among adults in primary care settings. Conclusion Screening, brief intervention, and referral for treatment are feasible and effective in primary care settings, provided that funding for screening is available, along with brief interventions and treatment facilities to which patients can be referred and treated promptly.
    04/2012; 3(1):25-34. DOI:10.2147/SAR.S30057
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    • "In addition to passively using IVR to monitor ongoing medical conditions, IVR is also applied as an adjunct to medical treatment. For example, IVR has been employed to assist with weight loss and cholesterol management [31], to facilitate healthier lifestyles in a pre-diabetic population [32], to help monitor and improve glucose levels in patients with diabetes [33], to teach and facilitate stress management techniques [34], to improve patient safety after hospital discharge [35], to provide brief intervention for alcohol abuse [13, 36–38], to assist with smoking cessation [39], and for clinical interventions such as self-administered psychotherapy for depression [40] and relapse prevention following cognitive behavioral therapy (CBT) for alcohol use [41]. "
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    ABSTRACT: Chronic pain is a medical condition that severely decreases the quality of life for those who struggle to cope with it. Interactive voice response (IVR) technology has the ability to track symptoms and disease progression, to investigate the relationships between symptom patterns and clinical outcomes, to assess the efficacy of ongoing treatments, and to directly serve as an adjunct to therapeutic treatment for chronic pain. While many approaches exist toward the management of chronic pain, all have their pitfalls and none work universally. Cognitive behavioral therapy (CBT) is one approach that has been shown to be fairly effective, and therapeutic interactive voice response technology provides a convenient and easy-to-use means of extending the therapeutic gains of CBT long after patients have discontinued clinical visitations. This review summarizes the advantages and disadvantages of IVR technology, provides evidence for the efficacy of the method in monitoring and managing chronic pain, and addresses potential future directions that the technology may take as a therapeutic intervention in its own right.
    03/2012; 2(1):93-101. DOI:10.1007/s13142-012-0115-x
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    • "Not all BI models involve face-to-face encounters. For instance, a study of SBI delivered by phone with interactive voice technology at a primary care center identified similar proportions of patients as responding positively to paper methods, and indicated a 24% reduction in alcohol consumed after 2 weeks [47, 48]. Computerized BI has been found to be effective [49]. "
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    ABSTRACT: The delivery of brief interventions (BIs) in health care settings to reduce problematic alcohol consumption is a key preventive strategy for public health. However, evidence of effectiveness beyond primary care is inconsistent. Patient populations and intervention components are heterogeneous. Also, evidence for successful implementation strategies is limited. In this article, recent literature is reviewed covering BI effectiveness for patient populations and subgroups, and design and implementation of BIs. Support is evident for short-term effectiveness in hospital settings, but long-term effects may be confounded by changes in control groups. Limited evidence suggests effectiveness with young patients not admitted as a consequence of alcohol, dependent patients, and binge drinkers. Influential BI components include high-quality change plans and provider characteristics. Health professionals endorse BI and feel confident in delivering it, but training and support initiatives continue to show no significant effects on uptake, prompting calls for systematic approaches to implementing BI in health care.
    Current Psychiatry Reports 07/2011; 13(5):422-9. DOI:10.1007/s11920-011-0219-x · 3.05 Impact Factor
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