Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention
Article first published online: 16 APR 2008
© 2008 The Authors. Journal compilation © 2008 Society for the Study of Addiction
Volume 103, Issue 8, pages 1271–1280, August 2008
How to Cite
Rose, H. L., Miller, P. M., Nemeth, L. S., Jenkins, R. G., Nietert, P. J., Wessell, A. M. and Ornstein, S. (2008), Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention. Addiction, 103: 1271–1280. doi: 10.1111/j.1360-0443.2008.02199.x
- Issue published online: 15 JUL 2008
- Article first published online: 16 APR 2008
- Submitted 3 July 2007; initial review completed 12 October 2007; final version accepted 15 January 2008
- Alcohol abuse;
- alcohol counseling;
- alcohol dependence;
- alcohol misuse;
- alcohol screening;
- alcohol use;
- brief intervention;
- high-risk drinking;
- primary care;
- research network
Aims To determine the effect of an intervention to improve alcohol screening and brief counseling for hypertensive patients in primary care.
Design Two-year randomized, controlled trial.
Setting/participants Twenty-one primary care practices across the United States with a common electronic medical record.
Intervention To promote alcohol screening and brief counseling. Intervention practices received site visits from study personnel and were invited to annual network meetings to review the progress of the project and share improvement strategies.
Measurements Main outcome measures included rates of documented alcohol screening in hypertensive patients and brief counseling administered in those diagnosed with high-risk drinking, alcohol abuse or alcohol dependence. Secondary outcomes included change in blood pressure among patients with these diagnoses.
Findings Hypertensive patients in intervention practices were significantly more likely to have been screened after 2 years than hypertensive patients in control practices [64.5% versus 23.5%; adjusted odds ratio (OR) = 8.1; 95% confidence interval (CI) 1.7–38.2; P < 0.0087]. Patients in intervention practices diagnosed with high-risk drinking, alcohol abuse or alcohol dependence were more likely than those in control practices to have had alcohol counseling documented (50.5% versus 29.6%; adjusted OR = 5.5, 95% CI 1.3–23.3). Systolic (adjusted mean decline = 4.2 mmHg, P = 0.036) and diastolic (adjusted mean decline = 3.3 mmHg, P = 0.006) blood pressure decreased significantly among hypertensive patients receiving alcohol counseling.
Conclusions Primary care practices receiving an alcohol-focused intervention over 2 years improved rates of alcohol screening for their hypertensive population. Implementation of alcohol counseling for high-risk drinking, alcohol abuse or alcohol dependence also improved and led to changes in patient blood pressures.