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


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.

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    • "Physicians’ attitudes towards patients and counseling for unhealthy alcohol use may also be another barrier. Knowing the factors that are associated with physicians’ screening and counseling behaviors for unhealthy alcohol use, and how these factors facilitate patients’ drinking behavior change, is paramount to improving patient health outcomes and providing quality care for patients with unhealthy alcohol use [6]. "
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    ABSTRACT: Objective Patients’ unhealthy alcohol use is often undetected in primary care. Our objective was to examine whether physicians’ attitudes and their perceived self-efficacy for screening and counseling patients is associated with physicians’ counseling of patients with unhealthy alcohol use, and patients’ subsequent drinking. Methods This study is a prospective cohort study (nested within a randomized trial) involving 41 primary care physicians and 301 of their patients, all of whom had unhealthy alcohol use. Independent variables were physicians’ attitudes toward unhealthy substance use and self-efficacy for screening and counseling. Outcomes were patients’ reports of physicians’ counseling about unhealthy alcohol use immediately after a physician visit, and patients’ drinking six months later. Results Neither physicians’ attitudes nor self-efficacy had any impact on physicians’ counseling, but greater perceived self-efficacy in screening, assessing and intervening with patients was associated with more drinking by patients six months later. Conclusions Future research needs to further explore the relationship between physicians’ attitudes towards unhealthy alcohol use, their self-efficacy for screening and counseling and patients’ drinking outcomes, given our unexpected findings.
    Full-text · Article · May 2013 · Substance Abuse Treatment Prevention and Policy
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    • "A Cochrane review found that brief intervention has been effective in primary care settings in lowering alcohol consumption.21 Brief intervention has also been found to decrease healthcare utilization and costs,22 and was associated with greater patient-perceived quality of primary care.23 National practice guidelines recommend routine use of screening and brief intervention for unhealthy alcohol use.24 "
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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.
    Full-text · Article · Apr 2010 · Journal of General Internal Medicine
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    • "For example, meta-analyses of randomized controlled trials (RCTs)2 of interventions to reduce risky alcohol use demonstrated decreased drinking for patients in primary care settings (Beich et al. 2003; Kaner et al. 2007). However, no such effects were found in meta-analyses of interventions delivered in hospital settings (Emmen et al. 2004), possibly because inpatients typically have greater severity of alcohol problems (i.e., most are alcohol dependent) (Saitz et al. 2007, 2008). Several high-quality RCTs of brief interventions delivered in emergency departments also detected no or limited benefit (D’Onofrio and Degutis 2002; Daeppen et al. 2007; Longabaugh et al. 2001; Monti et al. 1999). "
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    ABSTRACT: Alcohol use is common among people infected with HIV and may contribute to adverse consequences such as reduced adherence to treatment regimens and increased likelihood of risky sexual behaviors. Therefore, researchers and clinicians are looking for treatment approaches to reduce harmful alcohol consumption in this population. However, clinical trials of existing treatment models are scarce. A literature review identified only 11 studies that included HIV-infected patients with past or current risky alcohol use and which targeted alcohol use and other health behaviors. Four studies focusing on HIV-infected participants with alcohol problems found mixed effects on adherence and on alcohol use. Five clinical trials included at least 10 percent of HIV-infected subjects who use alcohol; of these, only one reported significant evidence of a favorable impact on alcohol consumption. Finally, two trials targeting alcohol users at high risk for HIV infection identified treatment effects that were not sustained. Taken together, these findings provide limited evidence of the benefit of behavioral interventions in this population. Nevertheless, these studies give some guidance for future interventions in HIV-infected patients with alcohol problems.
    Preview · Article · Mar 2010 · Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism
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