Training Primary Care Clinicians in Maintenance Care for Moderated Alcohol Use

Authors

  • Peter D. Friedmann MD, MPH,

    1. Program to Integrate Psychosocial and Health Services, Research Service, Providence Veterans Affairs Medical Center, Providence, RI, USA
    2. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    Search for more papers by this author
  • Jennifer Rose PhD,

    1. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    Search for more papers by this author
  • Jumi Hayaki PhD,

    1. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    2. Department of Psychology, St. Olaf College, Northfield, MN
    Search for more papers by this author
  • Susan Ramsey PhD,

    1. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    Search for more papers by this author
  • Anthony Charuvastra MD,

    1. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    Search for more papers by this author
  • Catherine Dubé EdD,

    1. Institute for Community Health Promotion, Brown Medical School, Providence, RI, USA.
    Search for more papers by this author
  • Debra Herman PhD,

    1. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    Search for more papers by this author
  • Michael D. Stein MD

    1. Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA
    Search for more papers by this author

  • No conflicts of interest to declare.

  • Presented in part at the Association for Medical Education and Research in Substance Abuse (AMERSA) 26th National Conference, November 9, 2002.

Address correspondence and requests for reprints to Dr. Friedmann: Rhode Island Hospital/Brown Medical School, 593 Eddy Street, Providence, RI 02903 (e-mail: pfriedmann@lifespan.org).

Abstract

OBJECTIVE: To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior.

DESIGN: We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 ¼ hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients' visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have “made a change in their drinking and are trying to keep it that way”; and that they drank <15 (men) or <10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician's actions during the visit.

RESULTS: Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit.

CONCLUSIONS: Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians' inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry.

Ancillary