Alcohol-related discussions during general medicine appointments of Male VA patients who screen positive for at-risk drinking

• Published in: Journal of general internal medicine : JGIM Vol. 17; no. 5; pp. 315 - 326
• Main Authors: BRADLEY, Katharine A, EPLER, Amee J, BUSH, Kristen R, SPORLEDER, Jennifer L, DUNN, Christopher W, COCHRAN, Nancy E, BRADDOCK, Clarence H, MCDONELL, Mary B, FIHN, Stephan D
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.05.2002; Springer Nature B.V
• Subjects: Addictive behaviors; Adult and adolescent clinical studies; Alcohol Drinking - psychology; Alcohol use; Alcoholism; Alcoholism - diagnosis; Ambulatory care; Ambulatory Care Facilities; Biological and medical sciences; Cardiovascular disease; Clinical trials; Female; Health care; Health services; Humans; Internal medicine; Intervention; Male; Medical sciences; Medicine; Middle Aged; Motivation; Patient Education as Topic; Patients; Primary care; Primary Health Care; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Questionnaires; R&D; Research & development; Substance Abuse Detection - psychology; Tape Recording; Veterans; White River; Puget Sound; Human; Primary health care; Alcoholism; Cross sectional study; Risk factor
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-002-0033-6

This study describes primary care discussions with patients who screened positive for at-risk drinking. In addition, discussions about alcohol use from 2 clinic firms, one with a provider-prompting intervention, are compared. Cross-sectional analyses of audiotaped appointments collected over 6 months. Male patients in a VA general medicine clinic were eligible if they screened positive for at-risk drinking and had a general medicine appointment with a consenting provider during the study period. Participating patients ( N = 47) and providers ( N = 17) were enrolled in 1 of 2 firms in the clinic (Intervention or Control) and were blinded to the study focus. Intervention providers received patient-specific results of positive alcohol-screening tests at each visit. Of 68 visits taped, 39 (57.4%) included any mention of alcohol. Patient and provider utterances during discussions about alcohol use were coded using Motivational Interviewing Skills Codes. Providers contributed 58% of utterances during alcohol-related discussions with most coded as questions (24%), information giving (23%), or facilitation (34%). Advice, reflective listening, and supportive or affirming statements occurred infrequently (5%, 3%, and 5%, of provider utterances respectively). Providers offered alcohol-related advice during 21% of visits. Sixteen percent of patient utterances reflected "resistance" to change and 12% reflected readiness to change. On average, Intervention providers were more likely to discuss alcohol use than Control providers (82.4% vs 39.6% of visits; P =.026). During discussions about alcohol, general medicine providers asked questions and offered information, but usually did not give explicit alcohol-related advice. Discussions about alcohol occurred more often when providers were prompted.