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Journal of General Internal Medicine

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01-08-2015 | Original Research

Association Between Receipt of Brief Alcohol Intervention and Quality of Care among Veteran Outpatients with Unhealthy Alcohol Use

Authors: Joseph A. Simonetti, MD, MPH, Gwen T. Lapham, PhD, MPH, MSW, Emily C. Williams, PhD, MPH

Published in: Journal of General Internal Medicine | Issue 8/2015

ABSTRACT

BACKGROUND

Brief alcohol intervention, including advice to reduce or abstain from drinking, is widely recommended for general medical outpatients with unhealthy alcohol use, but it is challenging to implement. Among other implementation challenges, providers report reluctance to deliver such interventions, citing concerns about negatively affecting their patient relationships.

OBJECTIVE

The purpose of this study was to determine whether patient-reported receipt of brief intervention was associated with patient-reported indicators of high-quality care among veteran outpatients with unhealthy alcohol use.

DESIGN

Cross-sectional secondary data analysis was performed using the Veterans Health Administration (VA) Survey of Healthcare Experiences of Patients (SHEP).

PARTICIPANTS

The study included veteran outpatients who (1) responded to the outpatient long-form SHEP (2009–2011), (2) screened positive for unhealthy alcohol use (Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire score ≥ 3 for women, ≥ 4 for men), and (3) responded to questions assessing receipt of brief intervention and quality of care.

MAIN MEASURES

We used logistic regression models to estimate the adjusted predicted prevalence of reporting two indicators of high-quality care—patient ratings of their VA provider and of overall VA healthcare (range 0–10, dichotomized as ≥ 9 indicating high quality)—for both patients who did and did not report receipt of brief intervention (receiving alcohol-related advice from a provider) within the previous year.

KEY RESULTS

Among 10,612 eligible veterans, 43.8 % reported having received brief intervention, and 84.2 % and 79.1 % rated their quality of care as high from their provider and the VA healthcare system, respectively. In adjusted analyses, compared to veterans who reported receiving no brief intervention, a higher proportion of veterans reporting receipt of brief intervention rated the quality of healthcare from their provider (86.9 % vs. 82.0 %, p < 0.01) and the VA overall (82.7 % vs. 75.9 %, p < 0.01) as high.

CONCLUSIONS

In this cross-sectional analysis of veterans with unhealthy alcohol use, a higher proportion of those who reported receipt of brief intervention reported receiving high-quality care compared to those who reported having received no such intervention. These findings do not support provider concerns that delivering brief intervention adversely affects patients’ perceptions of care.

Available only for authorised users

Williams EC, McFarland LV, Nelson KM. Alcohol consumption among urban, suburban, and rural Veterans Affairs outpatients. J Rural Health. 2012;28(2):202–210.PubMedCrossRef

Mertens JR, Weisner C, Ray GT, Fireman B, Walsh K. Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs. Alcohol Clin Exp Res. 2005;29(6):989–998.PubMedCrossRef

Saitz R. Unhealthy alcohol use. N Engl J Med. 2005;352(6):596–607.

Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the U.S., 2006. Am J Prev Med. 2011;41(5):516–524.

Centers for Disease Control and Prevention. Alcohol-attributable deaths and years of potential life lost—United States, 2001. MMWR 2004;53(37):866–870. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm. Accessed May 13, 214.

Kinder LS, Bryson CL, Sun H, Williams EC, Bradley KA. Alcohol screening scores and all-cause mortality in male Veterans Affairs patients. J Stud Alcohol Drugs. 2009;70(2):253–260.

Williams EC, Peytremann-Bridevaux I, Fan VS, et al. The association between alcohol screening scores and health status in male veterans. J Addict Med. 2010;4(1):27–37.PubMedCrossRef

Williams EC, Bryson CL, Sun H, et al. Association between alcohol screening results and hospitalizations for trauma in Veterans Affairs outpatients. Am J. Drug Alcohol Abuse. 2012;38(1):73–80.PubMedCrossRef

Kaner EF, Beyer F, Dickinson HO, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;2, CD004148.PubMed

10.

Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive services task force. Ann Intern Med. 2004;140(7):557–568.PubMedCrossRef

11.

Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med. 1997;12(5):274–283.PubMedCentralPubMedCrossRef

12.

U.S. Department of Health and Human Services. Helping patients who drink too much: a clinician’s guide, updated 2005 edition. Available at: http://www.niaaa.nih.gov/guide. Accessed June 4, 2014.

13.

U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140(7):554–556.CrossRef

14.

Moyer VA; U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(3):210–218.PubMed

15.

Nilsen P, Aalto M, Bendtsen P, Seppa K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review. Scand J Prim Health Care. 2006;24(1):5–15.PubMedCrossRef

16.

Williams EC, Johnson ML, Lapham GT, et al. Strategies to implement alcohol screening and brief intervention in primary care settings: a structured literature review. Psychol Addict Behav. 2011;25(2):206–214.PubMedCrossRef

17.

Substance Abuse and Mental Health Services Administration. Systems-level implementation of screening, brief intervention, and referral to treatment. Technical Assistance Publication (TAP) Series 33. HHS Publication No. (SMA)13-4741. Rockville, MD: 2013.

18.

Centers for Disease Control and Prevention. Vital signs: Communication between health professionals and their patients about alcohol use—44 states and the District of Columbia, 2011. MMWR 2014;63(01):16–22. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6301a4.htm?s_cid=mm6301a4_w. Accessed May 5, 2014.

19.

Beich A, Gannik D, Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ. Oct 19 2002;325(7369):870.

20.

Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15(2):84–91.PubMedCentralPubMedCrossRef

21.

Kääriäinen J, Sillanaukee P, Poutanen P, Seppä K. Opinions on alcohol-related issues among professionals in primary, occupational, and specialized health care. Alcohol Alcohol. 2001;36(2):141–146.PubMedCrossRef

22.

Aalto M, Pekuri P, Seppä K. Primary health care nurses' and physicians’ attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers. Addiction. 2001;96(2):305–311.PubMedCrossRef

23.

Lock CA, Kaner E, Lamont S, Bond S. A qualitative study of nurses’ attitudes and practices regarding brief alcohol intervention in primary health care. J Adv Nurs. 2002;39(4):333–342.PubMedCrossRef

24.

Cornuz J, Ghali WA, Di Carlantonio D, Pecoud A, Paccaud F. Physicians’ attitudes towards prevention: importance of intervention-specific barriers and physicians’ health habits. Fam Pract 2000;17(6):535–540.PubMedCrossRef

25.

Kaner EFS, Heather N, McAvoy BR, Lock CA, Gilvarry E. Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners. Alcohol Alcohol. 1999;34(4):559–566.PubMedCrossRef

26.

Saitz R, Horton NJ, Cheng DM, Samet JH. Alcohol counseling reflects higher quality of primary care. J Gen Intern Med. 2008;23(9):1482–1486.PubMedCentralPubMedCrossRef

27.

Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12(10):597–606.PubMed

28.

Lapham GT, Achtmeyer CE, Williams EC, Hawkins EJ, Kivlahan DR, Bradley KA. Increased documented brief alcohol interventions with a performance measure and electronic decision support. Med Care. 2012;50(2):179–187.PubMedCrossRef

29.

Bradley KA, Johnson ML, Williams EC. Commentary on Nilsen et al.: the importance of asking patients—the potential value of patient report of brief interventions. Addiction. 2011;106(10):1757–1759.PubMedCrossRef

30.

Kansagara D, Tuepker A, Joos S, Nicolaidis C, Skaperdas E, Hickam D. Getting performance metrics right: a qualitative study of staff experiences implementing and measuring practice transformation. J Gen Intern Med. 2014/02/21 2014:1–7.

31.

Wright SM, Craig T, Campbell S, Schaefer J, Humble C. Patient satisfaction of female and male users of Veterans Health Administration services. J Gen Intern Med. 2006;21(Suppl 3):S26–32.PubMedCentralPubMedCrossRef

32.

Perlin JB, Kolodner RM, Roswell RH. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manag Care. 2004;10(11 Pt 2):828–836.PubMed

33.

Survey of Healthcare Experiences of Patients (SHEP). Washington, DC: Office of Quality and Performance, Veterans Health Administration; 2004.

34.

CAHPS Overview Clinician & Group Surveys: Practical options for implementation and use. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/news/events/conference/2011/crofton/index.html. Accessed February 21, 2014.

35.

Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–1795.PubMedCrossRef

36.

Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch. Intern. Med. 2003;163(7):821–829.PubMedCrossRef

37.

Burman ML, Kivlahan D, Buchbinder M, et al. Alcohol-related advice for Veterans Affairs primary care patients: Who gets it? Who gives it? J. Stud. Alcohol. 2004;65(5):621–630.PubMedCrossRef

38.

Aligning Forces for Quality. How to report results of the CAHPS Clinician & Group Survey. Available at: http://www.facs.org/ahp/cahps/how-to-report-results.pdf. Accessed December 13, 2013.

39.

Kaner EF, Heather N, Brodie J, Lock CA, McAvoy BR. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract. 2001;51(471):822–827.PubMedCentralPubMed

40.

Arndt S, Schultz SK, Turvey C, Petersen A. Screening for alcoholism in the primary care setting: are we talking to the right people? J Fam Pract. 2002;51(1):41–46.PubMed

41.

O’Malley AJ, Zaslavsky AM, Elliott MN, Zaborski L, Cleary PD. Case-mix adjustment of the CAHPS hospital survey. Health Serv Res. 2005;40(6 Pt 2):2162–2181.PubMedCentralPubMedCrossRef

42.

Rubinsky AD, Kivlahan DR, Volk RJ, Maynard C, Bradley KA. Estimating risk of alcohol dependence using alcohol screening scores. Drug Alcohol Depend. 2010;108(1–2):29–36.PubMedCentralPubMedCrossRef

43.

Basu A, Rathouz PJ. Estimating marginal and incremental effects on health outcomes using flexible link and variance function models. Biostat. 2005;6(1):93–109.CrossRef

44.

Glick, et al. Economic Evaluation in Clinical Trials. Oxford: Oxford University Press; 2007.

45.

Williams EC, Chavez LJ, Lapham GT, Rittmueller SE, Achtmeyer CE, Bradley KA. An early evaluation of implementation of brief intervention for unhealthy alcohol use in the U.S. Veterans Health Administration. Addiction. 2014 Apr 29 [epub ahead of print].

46.

Aalto M, Seppa K. Usefulness, length and content of alcohol-related discussions in primary health care: the exit poll survey. Alcohol Alcohol. 2004;39(6):532–535.PubMedCrossRef

47.

Steven ID, Thomas SA, Eckerman E, Browning C, Dickens E. The provision of preventive care by general practitioners measured by patient completed questionnaires. J Qual Clin Pract. 1999;19(4):195–201.PubMedCrossRef

48.

Zimmerman M, Farber NJ, Hartung J, Lush DT, Kuzma MA. Screening for psychiatric disorders in medical patients: a feasibility and patient acceptance study. Med Care. 1994;32(6):603–608.PubMedCrossRef

49.

Miller PM, Thomas SE, Mallin R. Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians. Alcohol Alcohol. 2006;41(3):306–310.PubMedCrossRef

50.

Department of Health and Human Services. Preventive services covered under the Affordable Care Act. Available at: http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html. Accessed June 4, 2014.

51.

Center for Medicare & Medicaid Services (2011). Decision memo for screening and behavioral counseling interventions in primary care to reduce alcohol misuse (CAG-00427N). Available at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=249 - _ftn29. Accessed March 24, 2014.

52.

Center for Medicare & Medicaid Services. HCAHPS: Patients’ Perspectives of Care Survey. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html. Accessed July 24, 2014.

53.

Adamy J (12 Oct 2012). U.S. Ties Hospital Payments to Making Patients Happy. The Wall Street Journal. Available at: http://online.wsj.com/articles/SB10000872396390443890304578010264156073132. Accessed January 12, 2015.

54.

Rau J (28 Apr 2011). Medicare to Begin Basing Hospital Payments on Patient-Satisfaction Scores. Kaiser Health News. Available at: http://kaiserhealthnews.org/news/medicare-hospital-patient-satisfaction. Accessed January 12, 2015.

55.

Bradley KA, Lapham GT, Hawkins EJ, et al. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med. 2011;26(3):299–306.PubMedCentralPubMedCrossRef

56.

Seale JP, Boltri JM, Shellenberger S, et al. Primary care validation of a single screening question for drinkers. J Stud Alcohol. 2006;67(5):778–784.PubMedCrossRef

Title: Association Between Receipt of Brief Alcohol Intervention and Quality of Care among Veteran Outpatients with Unhealthy Alcohol Use
Authors: Joseph A. Simonetti, MD, MPH
Gwen T. Lapham, PhD, MPH, MSW
Emily C. Williams, PhD, MPH
Publication date: 01-08-2015
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 8/2015
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-015-3218-5

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Association Between Receipt of Brief Alcohol Intervention and Quality of Care among Veteran Outpatients with Unhealthy Alcohol Use

ABSTRACT

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

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ABSTRACT

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DESIGN

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KEY RESULTS

CONCLUSIONS

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