An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration

Authors

  • Emily C. Williams,

    Corresponding author
    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    2. Department of Health Services, University of Washington, Seattle, WA, USA
    • Correspondence to: Emily C. Williams, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA. E-mail: emily.williams3@va.gov

    Search for more papers by this author
  • Anna D. Rubinsky,

    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    Search for more papers by this author
  • Laura J. Chavez,

    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    2. Department of Health Services, University of Washington, Seattle, WA, USA
    Search for more papers by this author
  • Gwen T. Lapham,

    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    2. Group Health Research Institute, Seattle, WA, USA
    Search for more papers by this author
  • Stacey E. Rittmueller,

    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    Search for more papers by this author
  • Carol E. Achtmeyer,

    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    2. Primary and Specialty Medical Care Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    Search for more papers by this author
  • Katharine A. Bradley

    1. Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
    2. Department of Health Services, University of Washington, Seattle, WA, USA
    3. Group Health Research Institute, Seattle, WA, USA
    4. Department of Medicine, University of Washington, Seattle, WA, USA
    Search for more papers by this author

Abstract

Aims

The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation.

Design

Observational, retrospective cohort study using secondary clinical and administrative data.

Setting

Thirty VA facilities.

Participants

Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9–15 months later (n = 6210; 28%).

Measurements

Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking).

Findings

Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42–52%] and 48% (95% CI = 42–54%) for patients with and without documented brief intervention, respectively (P = 0.50).

Conclusions

During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.

Ancillary