Alcohol-related Discussions during General Medicine Appointments of Male VA Patients Who Screen Positive for At-risk Drinking

Authors

  • Katharine A. Bradley MD, MPH,

    Corresponding author
    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Amee J. Epler BA,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Kristen R. Bush MPH,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Jennifer L. Sporleder BS,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Christopher W. Dunn PhD,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Nancy E. Cochran MD,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Clarence H. Braddock III MD, MPH,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Mary B. McDonell MS,

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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  • Stephan D. Fihn MD, MPH

    1. Received from Northwest Health Services Research and Development Center of Excellence (KAB, AJE, JLS, MBM, SDF); the Primary and Specialty Medical Care Service (KAB, SDF) and Center of Excellence in Substance Abuse Research and Education (KRB), VA Puget Sound Health Care System; the Departments of Medicine (KAB, CHB, SDF), Health Services (KAB, CHB, SDF), Psychiatry and Behavioral Sciences (CWD), and Medical History and Ethics (CHB), University of Washington; the Harborview Injury Prevention and Research Center (CWD), Harborview Medical Center, Seattle, Wash; and the White River Junction VA Hospital (NEC) and the Department of Medicine and Community and Family Medicine (NEC), Dartmouth Medical School, White River Junction, Vt.
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Address correspondence and requests for reprints to Dr. Bradley: HSR&D (152), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108 (e-mail: willi@u.washington.edu).

Abstract

OBJECTIVE: 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.

DESIGN: Cross-sectional analyses of audiotaped appointments collected over 6 months.

PARTICIPANTS AND SETTING: 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: Intervention providers received patient-specific results of positive alcohol-screening tests at each visit.

MEASURES AND MAIN RESULTS: 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).

CONCLUSIONS: 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.

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