Alcohol counseling reflects higher quality of primary care

Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 08/2008; 23(9):1482-6. DOI: 10.1007/s11606-008-0574-4
Source: PubMed

ABSTRACT Some primary care physicians do not conduct alcohol screening because they assume their patients do not want to discuss alcohol use.
To assess whether (1) alcohol counseling can improve patient-perceived quality of primary care, and (2) higher quality of primary care is associated with subsequent decreased alcohol consumption.
A prospective cohort study.
Two hundred eighty-eight patients in an academic primary care practice who had unhealthy alcohol use.
The primary outcome was quality of care received [measured with the communication, whole-person knowledge, and trust scales of the Primary Care Assessment Survey (PCAS)]. The secondary outcome was drinking risky amounts in the past 30 days (measured with the Timeline Followback method).
Alcohol counseling was significantly associated with higher quality of primary care in the areas of communication (adjusted mean PCAS scale scores: 85 vs. 76) and whole-person knowledge (67 vs. 59). The quality of primary care was not associated with drinking risky amounts 6 months later.
Although quality of primary care may not necessarily affect drinking, brief counseling for unhealthy alcohol use may enhance the quality of primary care.

Download full-text


Available from: Nicholas Jon Horton, Aug 07, 2015
  • Source
    • "large evidence-based amount of data which show that SBI strategies are effective in primary care, particularly when applied under ideal clinical research conditions [8] [9]. However, evidence also suggests that some difficulties can emerge in the translation from theory to practice [8] [9] [10] [11] [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Screening and brief intervention (SBI) are considered good prevention strategies for alcohol-related problems in Primary Health Care (PHC). The aim of this study was to evaluate the process of an SBI implementation program for alcohol risk use and evaluate the factors that facilitated or impeded this implementation, in two PHC settings at the Brazilian city of Juiz de Fora. Case 1 public PHC services and case 2 the PHC service of the Military Police. Participants were trained on SBI strategies and supervised during 6 months. The qualitative methodology of action research was used. Data were analysed using thematic analysis. Case 1: 70 participants; facilitating factors: good expectations about the project; simplicity of SBI technique; collaborative way the project was planned. Barriers: lack of time; discomfort in dealing with alcohol issues; focus on alcohol-dependence; unstable political environment; other priorities; difficulties in patients' referral. Case 2: nine participants. Facilitating factors: simplicity of SBI technique; collaborative way the project was planned; importance of alcohol issues; data confidentiality and the voluntary work to do SBI. Barriers: only one health professional in the group; the variability of the institutional support; organisational culture about alcohol use. The barriers and facilitators were related to two main factors: organisational culture and personal attitudes. The action research provided the opportunity to bridge the gap between research and practice, but it also showed that SBI faces significant challenges before it can be implemented as a routine procedure in PHC settings in Brazil.
    Drug and Alcohol Review 03/2010; 29(2):162-8. DOI:10.1111/j.1465-3362.2009.00120.x · 1.55 Impact Factor
  • Source
    • "In recognition of the value of screening, brief intervention procedures, new reimbursable procedural codes (CPT ® , " H " , " G " for third party insurers, Medicaid, Medicare, respectively) were introduced in 2007 and 2008. As a further incentive for implementing these procedures, patients who receive counseling services for alcohol problems reportedly perceive that they are receiving a higher level of primary care (Saitz et al., 2008). Even with promising evidence of effectiveness, cost-effectiveness, positive patient response, the widespread implementation of even alcohol SBI procedures remains an elusive goal (Kuehn, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered.
    Drug and alcohol dependence 10/2008; 99(1-3):280-95. DOI:10.1016/j.drugalcdep.2008.08.003 · 3.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Equilibrium and arbitrage based option pricing models are based on the assumption that the derivative and its underlying asset are simultaneously ob-servable. However, empirical testing with transactions data must deal with less than perfect synchronicity and windows defining a "match" between the derivative and it underlying must be specified. A narrow window minimizes measurement error at the expense of a smaller sample size. The analysis in this paper assumes Poisson transaction arrivals and smooth diffusion price processes. Optimal windows and efficient estimators are derived and further evaluated by simulation. Benchmarks options are chosen using data from pit-traded S&P 500 futures options and Globex traded Euro options.
    Quantitative Finance 12/2007; 12(1). DOI:10.1080/14697680903386355 · 0.75 Impact Factor
Show more