Brief physician advice for problem drinking among older adults: An economic analysis of costs and benefits

Department of Family Medicine, University of Wisconsin, 777 South Mills Street, Madison, Wisconsin 53715, USA.
Journal of studies on alcohol 06/2005; 66(3):389-94. DOI: 10.15288/jsa.2005.66.389
Source: PubMed


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.

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Available from: Marlon P Mundt
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    • "With regards to the total duration of the intervention (i.e., the total contact time between patient and delivery staff, either face-to-face or over the telephone, aggregated over multiple contacts where appropriate), 12 studies evaluate interventions of 10 min or less (4, 13–15, 20, 23, 25, 28, 32, 33) and 11 consider interventions of over 10 min (with a maximum duration of 45 min) (4, 7, 13, 14, 16, 18, 21, 26, 28, 29). Again the heterogeneity of methods and outcomes makes direct comparison difficult, although there is no clear difference in terms of cost-effectiveness between shorter and longer interventions. "
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