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Martínez C, Camarelles Guillem F, González-Viana A, Sánchez Á, Tigova O, Fernández E. [From evidence to practice: The Disemination and Implementation Science in primary care]. Aten Primaria 2024; 57:103077. [PMID: 39265319 DOI: 10.1016/j.aprim.2024.103077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 09/14/2024] Open
Abstract
Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health.
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Affiliation(s)
- Cristina Martínez
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Salut Pública, Materno Infantil y Salud Mental, Facultad de Enfermería, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, EE. UU..
| | - Francisco Camarelles Guillem
- Centro de Salud Infanta Mercedes, Programa Actividades Preventivas y Promoción de la Salud PAPPS de semFYC, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Angelina González-Viana
- Servicio Catalán de la Salud - CatSalut, España; Grup d'Atenció Primària Orientada a la Comunitat (APOC) de CAMFIC, Barcelona, España
| | - Álvaro Sánchez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General OSAKIDETZA, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biobizkaia, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Olena Tigova
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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Córdoba García R, Camarelles Guillem F. [Screening and brief intervention on alcohol consumption]. Aten Primaria 2022; 54:102349. [PMID: 35550977 PMCID: PMC9108444 DOI: 10.1016/j.aprim.2022.102349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.
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Bachrach RL, Chinman M, Rodriguez KL, Mor MK, Kraemer KL, Garfunkel CE, Williams EC. Using practice facilitation to improve alcohol-related care in primary care: a mixed-methods pilot study protocol. Addict Sci Clin Pract 2022; 17:19. [PMID: 35287714 PMCID: PMC8919159 DOI: 10.1186/s13722-022-00300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background Alcohol use is a significant risk factor for disability and death in U.S. adults, and approximately one out of every six Veterans seen in primary care (PC) report unhealthy alcohol use. Unhealthy alcohol use is associated with increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g., pharmacotherapy) for those with alcohol use disorders (AUD). The VA pioneered implementing alcohol screening and BI in PC, yet substantial implementation gaps remain. To improve alcohol-related care, this study will conduct a pilot study to assess whether a multi-faceted evidence-based implementation strategy—practice facilitation—has the potential to improve PC-based alcohol-related care at a single VA clinic. Methods We will first recruit and conduct qualitative interviews with Veterans with unhealthy alcohol use (n = 20–25) and PC stakeholders (N = 10–15) to understand barriers and facilitators to high-quality alcohol care and use results to refine and hone the multifaceted practice facilitation intervention. Qualitative interviews, analysis, and refinement of the intervention will be guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups with a small sample of PC providers and staff (n = 5–7) will be used to further refine the practice facilitation intervention and assess its acceptability and feasibility. The refined practice facilitation intervention will then be offered in the PC clinic to assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes based on the RE-AIM framework. Discussion This research directly addresses one of the largest public health crises of our time, as alcohol kills more people than opioids and is associated with increased risk of suicide. If successful, this pilot may generate an intervention with far-reaching effects on adverse outcomes experienced by Veterans with unhealthy alcohol use, including increased access to care and suicide prevention. Trial registration Clinicaltrials.gov identifier: NCT04565899; Date of registration: 9/25/2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00300-x.
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Affiliation(s)
- Rachel L Bachrach
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240-1001, USA. .,Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, USA. .,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15260, USA.
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240-1001, USA.,Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, USA.,The RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240-1001, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240-1001, USA.,Deparatment of Biostistic, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Kevin L Kraemer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240-1001, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Cécile E Garfunkel
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, 98195, USA.,Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, 98108, USA
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Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review. AIDS Behav 2021; 25:1777-1789. [PMID: 33219492 DOI: 10.1007/s10461-020-03107-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
Abstract
Individuals with unhealthy alcohol use are at increased risk for HIV acquisition and may benefit from receiving HIV pre-exposure prophylaxis (PrEP) in primary care settings. To date, literature synthesizing what is known about the impact of unhealthy alcohol use on the PrEP care continuum with a focus on considerations for primary care is lacking. We searched OVID Medline and Web of Science from inception through March 19, 2020, to examine the extent, range, and nature of research on PrEP delivery among individuals with unhealthy alcohol use in primary care settings. We identified barriers and opportunities at each step along the PrEP care continuum, including for specific populations: adolescents, people who inject drugs, sex workers, and transgender persons. Future research should focus on identification of candidate patients, opportunities for patient engagement in novel settings, PrEP implementation strategies, and stigma reduction.
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Palfai TP, Kratzer MPL, Morone NE, Bernstein JA. Integrating patient perspectives in the development of a mobile health intervention to address chronic pain and heavy drinking in primary care: a qualitative study of patients in an urban, safety-net hospital setting. Addict Sci Clin Pract 2021; 16:20. [PMID: 33757584 PMCID: PMC7988929 DOI: 10.1186/s13722-021-00230-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic pain and heavy drinking are conditions that commonly co-occur among primary care patients. Despite the availability of behavioral interventions that target these conditions individually, engagement and adherence to treatment remain a challenge, and there have been no interventions designed to address both of these conditions together for patients presenting to primary care. This study seeks to incorporate the perspectives of patients regarding symptoms, treatment experiences, views on behavior change, and technology use to develop a tailored, integrated mobile health intervention that addresses both pain and heavy drinking among patients in primary care. Methods Twelve participants with moderate or greater chronic pain intensity and heavy drinking were recruited from primary care clinics in a large urban safety-net hospital. One-on-one interviews were recorded and transcribed. Codes were developed from interview transcripts, followed by thematic analysis in which specific meanings were assigned to codes. Participants also completed a series of Likert-based rating scales to evaluate components of the proposed intervention to supplement qualitative interviews. Results A number of themes were identified that had implications for intervention tailoring including: ambivalence about changing drinking, low expectations about pain treatment success, desire for contact with a designated provider, common use of smartphones but lack of familiarity with functions as a potential barrier to use, and strategies to maintain engagement and adherence. Evaluative ratings indicated that the proposed intervention content was perceived as helpful and the proposed structure, layout and design of the mobile intervention was acceptable to patients. Conclusions Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is an acceptable method of addressing chronic pain and heavy drinking among patients in primary care. The interviews highlight the need to utilize an intervention approach that addresses motivation to change drinking, sets realistic expectations for change, provides careful attention to training/education of the use of technology components, and fosters engagement through the use of reminders, feedback, and personalized activities.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA.
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA
| | - Natalia E Morone
- Department of Medicine, Section of Internal Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Judith A Bernstein
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, 4th Floor, Boston, MA, 02118, USA
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Perceived Positive Consequences Are Associated with Unhealthy Alcohol Use Among Persons Living with HIV. CANADIAN JOURNAL OF ADDICTION 2021; 11:23-31. [PMID: 33748407 DOI: 10.1097/cxa.0000000000000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Understanding how perceived positive consequences are associated with drinking may help improve effectiveness of alcohol reduction interventions among people living with HIV (PLWH). We aimed to determine whether perceived positive consequence scores varied by sociodemographic, drinking, mental health or substance use variables. Methods Perceived positive consequences of drinking were assessed using the PROMIS: Positive Consequences-Short Form. Unhealthy alcohol use was measured using a modified AUDIT-C. We used multiple linear regression to identify factors associated with perceived positive consequence. Results 328 PLWH who consumed at least one alcoholic beverage in the last 6 months participated in the Florida Cohort study (mean age=46, 69% male, 58% Black). Perceived positive consequence scores ranged from 0 to 28 (mean=16.1, SD=6.9). Perceived positive consequence scores increased by 0.8 points for each 1-point increase in AUDIT-C score. Demographics, thoughts on reducing alcohol use, other substance use, depression, and anxiety were not significantly associated with perceived positive consequences. Conclusions Our findings suggest perceived positive consequences are associated with unhealthy alcohol use. Positive consequences should be considered with negative consequences in a decisional balance when intervening on alcohol use among PLWH.
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Deng Y, Fiellin LE, O'Connor PG, Bedimo R, Gibert CL, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Tate JP, Justice AC, Bryant KJ, Fiellin DA. Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial. Addict Sci Clin Pract 2020; 15:28. [PMID: 32727618 PMCID: PMC7388231 DOI: 10.1186/s13722-020-00200-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND At-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol use. METHODS In this multi-site, randomized trial conducted between January 28, 2013 through July 14, 2017, we enrolled PWH and at-risk alcohol use [defined as alcohol consumption of ≥ 14 drinks per week or ≥ 4 drinks per occasion in men ≤ 65 years old or ≥ 7 drinks per week or ≥ 3 drinks per occasion in women or men > 65 years old]. ISAT (n = 46) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 47) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat principles. RESULTS Despite a multi-pronged approach, we only recruited 37% of the target population (n = 93/254). Among ISAT participants, 50% advanced to Step 2, among whom 57% advanced to Step 3. Participants randomized to ISAT and TAU had no observed difference in drinks per week over the past 30 days at week 24 (primary outcome) [least square means (Ls mean) (95% CI) = 8.8 vs. 10.6; adjusted mean difference (AMD) (95% CI) = - 0.4 (- 3.9, 3.0)]. CONCLUSION An insufficient number of patients were interested in participating in the trial. Efforts to enhance motivation of PWH with at-risk alcohol use to engage in alcohol-related research and build upon ISAT are needed. Trial registration Clinicaltrials.gov: NCT01410123, First posted August 4, 2011.
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Affiliation(s)
- E Jennifer Edelman
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.,College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, 06511, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, 06511, USA
| | - Lynn E Fiellin
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Patrick G O'Connor
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA
| | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX, 75216, USA
| | - Cynthia L Gibert
- D.C. VAMC and George, Washington University School of Medicine and Health Sciences, Washington, D.C, 20422, USA
| | - Vincent C Marconi
- Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA
| | - David Rimland
- Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY, 10010, USA
| | - Janet P Tate
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA
| | - Amy C Justice
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, 20892-7003, USA
| | - David A Fiellin
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA
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Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction 2020; 115:668-678. [PMID: 31642124 PMCID: PMC7725424 DOI: 10.1111/add.14836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
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Khan MR, Young KE, Caniglia EC, Fiellin DA, Maisto SA, Marshall BDL, Edelman EJ, Gaither JR, Chichetto NE, Tate J, Bryant KJ, Severe M, Stevens ER, Justice A, Braithwaite SR. Association of Alcohol Screening Scores With Adverse Mental Health Conditions and Substance Use Among US Adults. JAMA Netw Open 2020; 3:e200895. [PMID: 32163167 PMCID: PMC7068229 DOI: 10.1001/jamanetworkopen.2020.0895] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. OBJECTIVE To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from the Veterans Aging Cohort Study. Data were collected at 8 Veterans Health Administration facilities from 2003 through 2012. A total of 7510 participants were enrolled, completed a baseline survey, and were followed up. Veterans with HIV were matched with controls without HIV by age, race, sex, and site of care. Data were analyzed from January 2019 to December 2019. EXPOSURES The Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were used to assess alcohol use, with 4 risk groups delineated for each test: score 0 to 7 (reference), score 8 to 15, score 16 to 19, and score 20 to 40 (maximum score) for the full AUDIT and score 0 to 3 (reference), score 4 to 5, score 6 to 7, and score 8 to 12 (maximum score) for the AUDIT-C. MAIN OUTCOMES AND MEASURES Alcohol-clustering conditions, including self-reported symptoms of depression and anxiety and use of tobacco, marijuana, cocaine, other stimulants, opioids, and injection drugs. RESULTS A total of 6431 US patients (6104 [95%] men; median age during survey years 2003-2004, 50 years [range, 28-86 years; interquartile range, 44-55 years]) receiving care in the Veterans Health Administration completed 1 or more follow-up surveys when the AUDIT was administered and were included in the present analyses. Of the male participants, 4271 (66%) were African American, 1498 (24%) were white, and 590 (9%) were Hispanic. The AUDIT and AUDIT-C scores were associated with each alcohol-clustering condition. In particular, an AUDIT score of 20 or higher (vs <8, the reference) was associated with symptoms of depression (odds ratio [OR], 8.37; 95% CI, 6.20-11.29) and anxiety (OR, 8.98; 95% CI, 6.39-12.60) and with self-reported use of tobacco (OR, 14.64; 95% CI, 8.94-23.98), marijuana (OR, 12.41; 95% CI, 8.61-17.90), crack or cocaine (OR, 39.47; 95% CI, 27.38-56.90), other stimulants (OR, 21.31; 95% CI, 12.73-35.67), and injection drugs (OR, 8.67; 95% CI, 5.32-14.13). An AUDIT score of 20 or higher yielded likelihood ratio (sensitivity / 1 - specificity) values greater than 3.5 for depression, anxiety, crack or cocaine use, and other stimulant use. Associations between AUDIT-C scores and alcohol-clustering conditions were more modest. CONCLUSIONS AND RELEVANCE Alcohol screening can inform decisions about further screening and diagnostic assessment for alcohol-clustering conditions, particularly for depression, anxiety, crack or cocaine use, and other stimulant use. Future studies using clinical diagnoses rather than screening tools to assess alcohol-clustering conditions may be warranted.
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Affiliation(s)
- Maria R. Khan
- Department of Population Health, New York University School of Medicine, New York
| | - Kailyn E. Young
- Department of Population Health, New York University School of Medicine, New York
| | - Ellen C. Caniglia
- Department of Population Health, New York University School of Medicine, New York
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Julie R. Gaither
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Natalie E. Chichetto
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janet Tate
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - MacRegga Severe
- Department of Population Health, New York University School of Medicine, New York
| | - Elizabeth R. Stevens
- Department of Population Health, New York University School of Medicine, New York
| | - Amy Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Scott R. Braithwaite
- Department of Population Health, New York University School of Medicine, New York
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