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Variation in Documented Care for Unhealthy Alcohol Consumption Across Race/Ethnicity in the Department of Veterans Affairs Healthcare System

Authors

  • Emily C. Williams,

    Corresponding author
    1. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    • Health Services Research & Development (HSR&D), Seattle, Washington
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  • Gwen T. Lapham,

    1. Health Services Research & Development (HSR&D), Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    3. Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington
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  • Eric J. Hawkins,

    1. Health Services Research & Development (HSR&D), Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    3. Epidemiology Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
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  • Anna D. Rubinsky,

    1. Health Services Research & Development (HSR&D), Seattle, Washington
    2. Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington
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  • Leo S. Morales,

    1. Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington
    2. Department of Medicine, University of Washington, Seattle, Washington
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  • Bessie A. Young,

    1. Health Services Research & Development (HSR&D), Seattle, Washington
    2. Northwest Center of Excellence for Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
    3. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    4. Department of Health Services, University of Washington, Seattle, Washington
    5. Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington
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  • Katharine A. Bradley

    1. Northwest Center of Excellence for Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
    2. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
    3. Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington
    4. Department of Medicine, University of Washington, Seattle, Washington
    5. Group Health Research Institute, Seattle, Washington.
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Reprint requests: Emily C. Williams, PhD, MPH; VA Puget Sound Health Care System, Health Services Research & Development; 1100 Olive Way, Suite 1400, Seattle, WA 98101; Tel.: 206-277-6133; Fax: 206-764-2935; E-mail: emily.williams3@va.gov

Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, or Group Health Research Institute.

Abstract

Background

The VA Healthcare System has made progress implementing evidence-based care for unhealthy alcohol use, but whether there are differences in care across race/ethnicity is unclear. We describe alcohol-related care for 3 racial/ethnic groups among VA outpatients with unhealthy alcohol use.

Methods

This cross-sectional study utilized secondary quality improvement data collected for the VA Office of Quality and Performance (July 2006 to June 2007) to identify a sample of 9,194 black (= 1,436), Hispanic (= 500), and white (= 7,258) VA outpatients who screened positive for unhealthy alcohol use (AUDIT-C score ≥4 men; ≥3 women). Alcohol-related care was defined as medical record documentation of brief intervention (advice or feedback) and/or referral (discussion of or scheduled). Logistic regression models estimated the prevalence of alcohol-related care among black, Hispanic, and white patients after adjustment for sociodemographic characteristics, alcohol use severity, other substance use, and mental health comorbidity.

Results

Among all eligible patients, 2,903 (32%) had documented alcohol-related care. Adjusted prevalences were 35.3% (95% CI 30.0 to 40.5) for black, 27.3% (95% CI 21.1 to 33.5) for Hispanic, and 28.9% (95% CI 25.5 to 32.3) for white patients. Differences in documented alcohol-related care between all racial/ethnic groups were significant (p-values all < 0.05).

Conclusions

Among VA patients with unhealthy alcohol use, black patients had the highest, and Hispanic the lowest, prevalence of documented alcohol-related care. Future research should evaluate contextual and system-, provider-, or patient-level factors that may attenuate racial/ethnic differences in documented alcohol-related care, as well as whether differences in documented care are associated with differences in outcomes.

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