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Williams EC, Lapham GT, Rubinsky AD, Chavez LJ, Berger D, Bradley KA. Influence of a targeted performance measure for brief intervention on gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the Veterans Health Administration. J Subst Abuse Treat 2017; 81:11-16. [PMID: 28847450 DOI: 10.1016/j.jsat.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/09/2017] [Accepted: 07/18/2017] [Indexed: 11/26/2022]
Abstract
AIMS Women are less likely than men to receive brief intervention (BI) for unhealthy alcohol use. In 2007, the U.S. Veterans Health Administration (VA) used a national performance measure to implement BI. Although AUDIT-C scores ≥3 for women and ≥4 for men optimize sensitivity and specificity for identifying unhealthy alcohol use, VA's performance measure required BI only among a targeted subgroup defined by a non-gender-specific score threshold (AUDIT-C ≥5). This may have influenced gender differences in receipt of BI among those optimally eligible for BI. Therefore, we evaluate differences in proportions of women and men offered BI before and after BI implementation. METHODS National secondary chart review data (7/06-6/10) identified all outpatients with unhealthy alcohol use for whom BI would be indicated (AUDIT-C ≥3 women, ≥4 men). Logistic regression, including a time-by-gender interaction, estimated the prevalence and 95% confidence interval (CI) of BI for women and men pre- and post-implementation. FINDINGS Among patients optimally eligible for BI (n=51,272, 8206 women and 43,066 men), the prevalence of BI increased more steeply for men than women after implementation (interaction p-value <0.0001). Pre-implementation rates of BI were 21% (95% CI, 18-24) for women and 26% (95% CI, 24-29) for men, and post-implementation rates were 32% (95% CI, 30-34) for women and 47% (95% CI, 45-49) for men. CONCLUSIONS Healthcare systems implementing BI with performance measures may wish to consider that specifying a single alcohol screening threshold for men and women may increase gender differences in receipt of BI among patients likely to benefit.
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Affiliation(s)
- 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, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
| | - Anna D Rubinsky
- The Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States.
| | - Laura J Chavez
- Ohio State University, School of Public Health, Columbus, OH, United States.
| | - Douglas Berger
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States.
| | - Katharine A Bradley
- Center of Excellence for Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
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Williams EC, Rubinsky AD, Lapham GT, Chavez LJ, Rittmueller SE, Hawkins EJ, Grossbard JR, Kivlahan DR, Bradley KA. Prevalence of clinically recognized alcohol and other substance use disorders among VA outpatients with unhealthy alcohol use identified by routine alcohol screening. Drug Alcohol Depend 2014; 135:95-103. [PMID: 24360928 DOI: 10.1016/j.drugalcdep.2013.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/11/2013] [Accepted: 11/16/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of routine alcohol screening is to identify patients who may benefit from brief intervention, but patients who also have alcohol and other substance use disorders (AUD/SUD) likely require more intensive interventions. This study sought to determine the prevalence of clinically documented AUD/SUD among VA outpatients with unhealthy alcohol use identified by routine screening. METHODS VA patients 18-90 years who screened positive for unhealthy alcohol use (AUDIT-C ≥3 women; ≥4 men) and were randomly selected for quality improvement standardized medical record review (6/06-6/10) were included. Gender-stratified prevalences of clinically documented AUD/SUD (diagnosis of AUD, SUD, or alcohol-specific medical conditions, or VA specialty addictions treatment on the date of or 365 days prior to screening) were estimated and compared across AUDIT-C risk groups, and then repeated across groups further stratified by age. RESULTS Among 63,397 eligible patients with unhealthy alcohol use, 25% (n=2109) women and 28% (n=15,199) men had documented AUD/SUD (p<0.001). The prevalence of AUD/SUD increased with increasing AUDIT-C risk, ranging from 13% (95% CI 13-14%) to 82% (79-85%) for women and 12% (11-12%) to 69% (68-71%) for men in the lowest and highest AUDIT-C risk groups, respectively. Patterns were similar across age groups. CONCLUSIONS One-quarter of all patients with unhealthy alcohol use, and a majority of those with the highest alcohol screening scores, had clinically recognized AUD/SUD. Healthcare systems implementing evidence-based alcohol-related care should be prepared to offer more intensive interventions and/or effective pharmacotherapies for these patients.
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Affiliation(s)
- Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
| | - Anna D Rubinsky
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Gwen T Lapham
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Group Health Research Institute, Seattle, WA, United States
| | - Laura J Chavez
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Stacey E Rittmueller
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
| | - Eric J Hawkins
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Joel R Grossbard
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
| | - Daniel R Kivlahan
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Katharine A Bradley
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Group Health Research Institute, Seattle, WA, United States
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Bradley KA, Rubinsky AD. Why not add consumption measures to current definitions of substance use disorders? Commentary on Rehm et al.: 'Defining substance use disorders: do we really need more than heavy use?'. Alcohol Alcohol 2013; 48:642-3. [PMID: 23955834 DOI: 10.1093/alcalc/agt132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The article by Rehm and colleagues in this issue of the Journal argues that diagnoses of substance use disorders should be based solely on measures of consumption. Although the authors provide convincing arguments for inclusion of consumption measures in the diagnostic criteria for substance use disorders, we do not agree that diagnostic criteria should be restricted to measures of consumption alone. Our clinical and research experience with alcohol use disorders suggests that use of consumption measures alone would fail to identify many patients whose alcohol or drug use is adversely impacting their health. Instead, we advocate-as others have done-that measures of consumption be added to current diagnostic criteria.
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Affiliation(s)
- Katharine A Bradley
- Correspondence author: Group Health Research Institute, Metropolitan Park East, 1730 Minor Avenue, Ste. 1600, Seattle, WA 98101, USA.
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