Brief physician advice for problem drinking among older adults: an economic analysis of costs and benefits.
ABSTRACT Problem alcohol use among elderly persons can have a variety of health-related consequences, complicating management of chronic illnesses and increasing health care utilization and costs. This study evaluates the economic cost and benefits of brief intervention for at-risk drinking older adults.
A controlled clinical trial with 24-month follow-up tested effectiveness of brief physician advice in reducing alcohol use, health care utilization and other consequences among older (age 65 or older) adult problem drinkers. Of 6,073 patients screened for problem drinking in 24 community-based primary care practices in Wisconsin, 158 patients met inclusion criteria and were randomized into control (n = 71) or intervention (n = 87) groups. Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions including professional advice, education and contracting using scripted workbooks.
The intervention group demonstrated significant reductions in alcohol use (p = 0.001) and frequency of excessive drinking (p = 0.03) compared with the control group over 24 months, but no significant differences emerged in economic outcomes, including hospital days, emergency department visits, office visits, medications, lab and x-ray procedures, injuries, legal events or mortality.
Although the clinical benefits of brief alcohol interventions with older adults are clear, the economic results in this age group are less certain. Older adult problem drinkers may require more intensive and costly interventions to achieve economic benefits similar to those seen in younger adult problem drinkers. Methodological issues, such as statistical power, outcome measures, outlier cases and follow-up periods, are identified for future evaluations.
Full-textDOI: · Available from: Marlon P Mundt, Jul 21, 2015
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ABSTRACT: Basic economic theory suggests that health insurance coverage may cause a reduction in prevention activities, but empirical studies have yet to provide much evidence to support this prediction. However, in other insurance contexts that involve adverse health events, evidence of ex ante moral hazard is more consistent. In this paper, we extend the analysis of the effect of health insurance on health behaviors by allowing for the possibility that health insurance has a direct (ex ante moral hazard) and indirect effect on health behaviors. The indirect effect works through changes in health promotion information and the probability of illness that may be a byproduct of insurance-induced greater contact with medical professionals. We identify these two effects and in doing so identify the pure ex ante moral hazard effect. This study exploits the plausibly exogenous variation in health insurance as a result of obtaining Medicare coverage at age 65. We find evidence that obtaining health insurance reduces prevention and increases unhealthy behaviors among elderly men. We also find evidence that physician counseling is successful in changing health behaviors.International Journal of Health Care Finance and Economics 04/2009; 9(4):367-90. DOI:10.1007/s10754-009-9056-4 · 0.49 Impact Factor
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- "Of these 26 were excluded. Eight papers were sub-analyses of previously published data (Adams et al., 1998; Fleming et al., 2000, 2002; Freeborn et al., 2000; Gordon et al., 2003; Grossberg et al., 2004; Manwell et al., 2000; Mundt et al., 2005). Four papers were long-term follow-ups of previously published trials (Kristenson et al., 2002; Nilssen, 2004; Reiff-Hekking et al., 2005; Wutzke et al., 2002). "
ABSTRACT: To determine whether socio-economic status (SES) influences (i) willingness to participate in brief intervention (BI) research, (ii) attendance to receive BI once allocated, and (iii) treatment outcome. Systematic review of published, randomised controlled trials of BI for non-dependent alcohol misuse in primary health care settings. Eighteen papers met inclusion criteria. There is evidence that once recruited, and following attendance for intervention, participants' SES does not influence treatment outcome. However, the effect of choosing to participate remains unclear, and the generalizability of results to the whole primary care population remains equivocal. Socio-economic status may influence willingness to participate in BI treatment research, and may influence attendance to receive such interventions where allocated. Brief interventions should remain available to all non-dependent hazardous and harmful drinkers in primary care. However, fidelity to research design is suggested to allow for any participation effects to occur. Benefits of such an approach exist for both clinicians and patients. The characteristics of those who participate in BI trials, compared to those who do not, should be studied in detail. Socio-economic variables should be included as potentially important characteristics. The impact of BI on drinking style as well as consumption needs further attention.Alcohol and Alcoholism 06/2006; 41(5):540-5. DOI:10.1093/alcalc/agl053 · 2.09 Impact Factor
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ABSTRACT: This report reviews a wide variety of evidence regarding traffic safety in the United States, with specific reference to military personnel. The report has two broad organizing themes: first, who is most at risk for being in a vehicle crash; and second, what measures can be taken to alleviate this risk. In terms of such measures, the report focuses on safety interventions and attempts to change driver behavior and decisions.