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Yimsaard P, Mootz JJ, Rungnirundorn T, Janamnuaysook R, Samitpol K, Phanuphak N, Wainberg ML. Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed-method pre-implementation study using the Consolidated Framework for Implementation Research. Addiction 2024; 119:863-874. [PMID: 38168887 PMCID: PMC11009091 DOI: 10.1111/add.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. DESIGN A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews. SETTING The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand. PARTICIPANTS In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. MEASUREMENTS Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. FINDINGS Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. CONCLUSION Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer J. Mootz
- Columbia University Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Teerayuth Rungnirundorn
- Department of Psychiatry, King Chulalongkorn Memorial Hospital Thai Red Cross Society, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Conigrave JH, Devine EK, Lee KSK, Dobbins T, Vnuk J, Hayman N, Conigrave K. Unintended consequences: Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns. Drug Alcohol Rev 2023; 42:1633-1638. [PMID: 37867367 PMCID: PMC10946595 DOI: 10.1111/dar.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Regular screening for risky drinking is important to improve the health of Aboriginal and Torres Strait Islander Australians. We explored whether the rate of screening for risky drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions was disrupted at Aboriginal Community Controlled Health Services (ACCHS) during state-wide and territory-wide COVID-19 lockdowns in 2020. METHODS Retrospective analysis of screening data from 22 ACCHSs located in New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia. These services provide holistic and culturally appropriate primary care. A multi-level Poisson regression, including AR(1) autocorrelation, was used to predict counts of AUDIT-C screening at ACCHSs. RESULTS AUDIT-C screening was suppressed during state-wide and territory-wide lockdowns in 2020 (incident rate ratio [IRR] 0.42 [0.29, 0.61]). The effect of lockdowns differed by service remoteness. While there was a substantial reduction in AUDIT-C screening for urban and inner regional services (IRR 0.25 [95% confidence interval (CI) 0.15, 0.42]), there was not a statistically significant change in screening at outer regional and remote (IRR 0.60 [95% CI 0.33, 1.09]) or very remote services (IRR 0.67 [95% CI 0.40, 1.11]). DISCUSSION AND CONCLUSIONS The COVID-19 lockdowns in Australia likely suppressed rates of screening for risky drinking in urban and inner regional regions. As harm from alcohol consumption may have increased during lockdowns, policymakers should consider implementing measures to enable screening for risky drinking to continue during future lockdowns.
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Affiliation(s)
- James H. Conigrave
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
- Centre of Research Excellence in Indigenous Health and AlcoholThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Institute for Positive Psychology and Education, Australian Catholic UniversitySydneyAustralia
| | - Emma K. Devine
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
- Centre of Research Excellence in Indigenous Health and AlcoholThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
- National Drug Research Institute, Faculty of Health Sciences, Curtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
| | | | - Julia Vnuk
- Aboriginal Health Council of South AustraliaAdelaideAustralia
- Adelaide Rural Clinical SchoolThe University of AdelaideAdelaideAustralia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health CareBrisbaneAustralia
- School of MedicineUniversity of QueenslandBrisbaneAustralia
- School of MedicineGriffith University, Gold Coast CampusGold CoastAustralia
| | - Katherine Conigrave
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
- Centre of Research Excellence in Indigenous Health and AlcoholThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health DistrictSydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyAustralia
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Silver CM, Visenio MR, Thomas AC, Reddy S, Raven MC, Kanzaria HK, Plevin RE, Stey AM. Hospital variability in adoption of alcohol and drug screening in adult trauma patients. J Trauma Acute Care Surg 2023; 94:684-691. [PMID: 36801898 PMCID: PMC10133007 DOI: 10.1097/ta.0000000000003928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Despite recommendations to screen all injured patients for substance use, single-center studies have reported underscreening. This study sought to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in the Trauma Quality Improvement Program. METHODS This was a retrospective observational cross-sectional study of trauma patients 18 years or older in Trauma Quality Improvement Program 2017-2018. Hierarchical multivariable logistic regression modeled the odds of screening for alcohol and drugs via blood/urine test while controlling for patient and hospital variables. We identified statistically significant high and low-screening hospitals based on hospitals' estimated random intercepts and associated confidence intervals (CIs). RESULTS Of 1,282,111 patients at 744 hospitals, 619,423 (48.3%) were screened for alcohol, and 388,732 (30.3%) were screened for drugs. Hospital-level alcohol screening rates ranged from 0.8% to 99.7%, with a mean rate of 42.4% (SD, 25.1%). Hospital-level drug screening rates ranged from 0.2% to 99.9% (mean, 27.1%; SD, 20.2%). A total of 37.1% (95% CI, 34.7-39.6%) of variance in alcohol screening and 31.5% (95% CI, 29.2-33.9%) of variance in drug screening were at the hospital level. Level I/II trauma centers had higher adjusted odds of alcohol screening (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.41) and drug screening (aOR, 1.16; 95% CI, 1.08-1.25) than Level III and nontrauma centers. We found 297 low-screening and 307 high-screening hospitals in alcohol after adjusting for patient and hospital variables. There were 298 low-screening and 298 high-screening hospitals for drugs. CONCLUSION Overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals. These results underscore an important opportunity to improve the care of injured patients and reduce rates of substance use and trauma recidivism. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Casey M. Silver
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael R. Visenio
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Arielle C. Thomas
- American College of Surgeons, Chicago, IL
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Susheel Reddy
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maria C. Raven
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
| | - Hemal K. Kanzaria
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
| | - Rebecca E. Plevin
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Anne M. Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Olusanya OA, Greene KM, Rossheim ME, Barry AE. Midwives' knowledge and perceived barriers to screening alcohol use among pregnant women in a southwestern US state. Drug Alcohol Rev 2023; 42:384-388. [PMID: 36478421 DOI: 10.1111/dar.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Alcohol consumption during pregnancy can produce multiple damaging outcomes to the foetus, commonly referred to as fetal alcohol spectrum disorders (FASD). FASD represents the leading non-genetic cause of preventable birth defects in the United States where alcohol guidelines recommend pregnant woman abstain from alcohol use. This study examined: (i) midwives' knowledge, attitude and intent to screen for prenatal alcohol use; and (ii) assessed perceived barriers to communicating alcohol-related information. METHODS Using an online questionnaire, data were obtained from midwives (n = 61) in a southwestern US state between March and May 2018. Descriptive statistics were used to describe midwives' knowledge, attitude, intent and perceived barriers. RESULTS Several midwives considered one alcoholic beverage per occasion to be safe for the foetus (20.3%), some thought alcohol was safe during the 3rd trimester (14.8%) only and few thought it was safe in all trimesters. Many midwives (63.3%) were unaware that the TWEAK and T-ACE were validated alcohol screening tools for pregnant women. Furthermore, most midwives (>50%) agreed that limited time with patients, a need for additional training and lack of information on referral resources interfered with their sharing of alcohol abstinence guidelines. Midwives reported highly favourable attitudes and intentions toward sharing alcohol abstinence messages with their pregnant patients. DISCUSSION AND CONCLUSIONS More in-depth research and larger samples are needed to explore barriers (knowledge gaps, limited time with patients, need for additional training) that hinder midwives' dissemination of abstinence messages to pregnant women and limit the uptake of validated alcohol screening tools.
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Affiliation(s)
- Olufunto A Olusanya
- Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, USA
- Department of Health and Kinesiology, Texas A&M University, College Station, USA
| | - Kaylin M Greene
- Department of Sociology and Anthropology, Montana State University, Bozeman, USA
| | - Matthew E Rossheim
- Department of Health Behavior and Health Systems, The University of North Texas Health Science Center, Fort Worth, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, USA
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Kokole D, Mercken L, Anderson P, Mejía-Trujillo J, Perez-Gomez A, Bustamante I, Piazza M, Natera Rey G, Arroyo M, Pérez De León A, Bautista Aguilar N, Medina Aguilar PS, Schulte B, O'Donnell A, de Vries H, Jané-Llopis E. Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru. Glob Public Health 2023; 18:2207410. [PMID: 37156224 DOI: 10.1080/17441692.2023.2207410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Health Psychology, Open University, Heerlen, Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | | | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- ESADE, Universitat Ramon Llull, Barcelona, Spain
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Metz VE, Palzes VA, Kline-Simon AH, Chi FW, Weisner CM, Sterling SA. Predicting severe alcohol use disorders in primary care using number of heavy drinking days. Addiction 2022; 117:2847-2854. [PMID: 35852025 DOI: 10.1111/add.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Although screening for unhealthy alcohol use is becoming more common, severe alcohol use disorders (AUDs) associated with the most severe medical and socio-economic sequelae still often go unidentified in primary care. To improve identification of severe AUDs and aid clinical decision-making, we aimed to identify a threshold of heavy drinking days (HDDs) associated with severe AUDs. DESIGN, SETTING AND CASES This cohort study analyzed electronic health record data of 138 765 adults who reported ≥ 1 HDD (4+ drinks/occasion for women and men aged ≥ 65 years, 5+ for men aged 18-64 years) during a 3-month period at a routine alcohol screening in primary care in a large Northern California, USA health-care system from 2014 to 2017. Our sample was 66.5% male, 59.7% white, 11.0% Asian/Pacific Islander, 5.0% black, 17.4% Latino/Hispanic and 7.0% other/unknown race/ethnicity; the mean age was 40.6 years (standard deviation = 15.2). MEASUREMENTS We compared sensitivity and specificity of different thresholds of the reported number of HDDs during a 3-month period for predicting severe AUD diagnoses in the following year, in the full sample and by sex and age. FINDINGS The prevalence of severe AUD diagnoses in the year after the screening was 0.6%. The optimal threshold predicting future severe AUD diagnoses in the full sample was ≥ 5 HDDs during a 3-month period [sensitivity = 68.9%, 95% confidence interval (CI) = 65.9, 72.0; specificity = 63.2%, 95% CI = 62.9, 63.4], but varied by sex and age. Women had a lower threshold than men (4 versus 6 HDDs), which decreased as women aged (from 5 HDDs among 18-24 years to 4 HDDs ≥ 25 years), but increased as men aged (from 5 HDDs among 18-24 years to 6 HDDs among 25-64 years, to 7 HDDs ≥ 65 years). CONCLUSIONS Five or more heavy drinking days in a 3-month period may indicate heightened risk of future severe alcohol use disorder in an adult primary care population. The optimal thresholds are lower for women than for men, and thresholds decrease as women age but increase as men age.
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Affiliation(s)
- Verena E Metz
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA
| | - Vanessa A Palzes
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA
| | - Andrea H Kline-Simon
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA
| | - Felicia W Chi
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA
| | - Constance M Weisner
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA.,UCSF Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - Stacy A Sterling
- Kaiser Permanente Division of Research, Center for Addiction and Mental Health Research, Oakland, CA, USA.,UCSF Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Hoopsick RA, Vest BM, Homish DL, Homish GG. Differences in alcohol screening and alcohol problems among United States veterans based on military service history. Psychol Serv 2022; 19:710-718. [PMID: 34516202 PMCID: PMC8918068 DOI: 10.1037/ser0000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military deployment is a risk factor for alcohol problems, and postdeployment alcohol problems are more prevalent among part-time reservists than full-time active duty service members. However, emerging research suggests that reservists who never experience deployment are also at risk. We examined if never-deployed/activated reserve veterans differed from active duty/deployed veterans in alcohol screening and misuse. Using pooled cross-sectional data from the National Survey on Drug Use and Health (NSDUH; 2015-2019), we estimated the prevalence of past-year self-reported alcohol screening by a health care provider and measured DSM-IV alcohol abuse and alcohol dependence among U.S. veterans aged 18-49 years with at least one health care visit in the past year (N = 4,148). We used regression models to examine for differences in these outcomes between never-deployed/activated reserve veterans and active duty/deployed veterans. Overall, 15% of veterans reported not being screened for alcohol use, despite 1 in 11 meeting DSM-IV criteria for alcohol abuse/dependence. Active duty/deployed veterans were more likely to have been screened for alcohol use than never-deployed/activated reserve veterans (p < .05). However, there was no difference in past-year alcohol abuse (p > .05) or dependence (p > .05) between never-deployed/activated reserve veterans and veterans with a history of active duty service/activation. Never-deployed/activated reserve veterans are less likely to be screened for alcohol use than active duty/deployed veterans, despite no significant difference in meeting alcohol abuse/dependence criteria. Providers may not recognize never-deployed reservists as veterans. We recommend systematic screening for military service history and alcohol use for all veterans, regardless of deployment/active duty service. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Family Medicine, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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Chatterton B, Agnoli A, Schwarz EB, Fenton JJ. Alcohol Screening During US Primary Care Visits, 2014-2016. J Gen Intern Med 2022; 37:3848-52. [PMID: 35048299 DOI: 10.1007/s11606-021-07369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Unhealthy alcohol use is a significant health issue for the US population. The US Preventive Services Task Force (USPSTF) recommends screening adults 18 years or older for unhealthy alcohol use during primary care visits. OBJECTIVES To evaluate alcohol screening among ambulatory visits made by US adult primary care patients and identify characteristics predictive of alcohol screening. DESIGN A series of cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) data collected from 2014 to 2016 was used to examine US primary care providers' use of alcohol screening questionnaires and delivery of counseling on alcohol use. PARTICIPANTS A total of 19,213 visits made by patients aged 18 years or older to a US primary care physician trained in family medicine or internal medicine. MAIN MEASURES Administration of a validated alcohol screening questionnaire and counseling/education on alcohol use. Variation in alcohol screening by patient demographic characteristics, reason for office visit, length of office visit, chronic medical conditions, evaluation by assigned primary care physician, new patient to practice, and region. KEY RESULTS Alcohol screening with a validated questionnaire occurred during 2.6% (95% Cl: 0.9%, 4.3%) of visits. Alcohol counseling, provided either by the physician or by referral, was documented in 0.8% (95% Cl: 0.3%, 1.3%) of visits. Screening was significantly more likely if patients were seen by their assigned primary care physician (adjOR 4.38 (95% Cl: 1.41, 13.61)), a new patient to the practice (adjOR 4.18 (95% Cl: 2.30, 7.79)), or had several chronic medical conditions (adjOR 3.40 (95% Cl: 1.48, 7.78)). Patients' sex, race/ethnicity, age group, or length of appointment time was not associated with screening for unhealthy alcohol use. CONCLUSIONS Screening for unhealthy alcohol use using a validated questionnaire is uncommonly performed during US primary care visits. Interventions or incentives may be needed to increase uptake of USPSTF alcohol screening recommendations.
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Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury‐Birch D, Patton R, Pellat‐Higgins T, Phillips C, Phillips T, Pockett RD, Russell IT, Strang J, Drummond C. Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high-risk adolescents presenting to emergency departments: three-arm pragmatic randomized trial (SIPS Junior high risk trial). Addiction 2022; 117:2200-2214. [PMID: 35315170 PMCID: PMC9540754 DOI: 10.1111/add.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. DESIGN, SETTING AND PARTICIPANTS Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. INTERVENTIONS Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. MEASURES The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. FINDINGS At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38-3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs consumed 0.19 (-0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (-£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. CONCLUSIONS In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.
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Affiliation(s)
- Paolo Deluca
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Simon Coulton
- Centre for Health Services StudiesUniversity of KentCanterburyUK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU HealthQatar UniversityQatar
| | - Sadie Boniface
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Institute of Alcohol StudiesAlliance HouseLondonUK
| | - Kim Donoghue
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas HospitalNewcastle upon TyneUK,Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Eileen Kaner
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Ellen Lynch
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Ian Maconochie
- Paediatric Emergency MedicineImperial College London, Queen Elizabeth the Queen Mother Wing, St Mary's HospitalLondonUK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas HospitalNewcastle upon TyneUK
| | - Ruth McGovern
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | | | - Robert Patton
- School of Psychology, Elizabeth Fry Building (AD)University of SurreyGuildfordUK
| | | | | | - Thomas Phillips
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Institute for Clinical and Applied Health ResearchUniversity of HullHullUK
| | | | - Ian T. Russell
- Swansea Centre for Health Economics, College of Human and Health SciencesSwansea UniversitySwanseaUK
| | - John Strang
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Colin Drummond
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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10
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Dzidowska M, Lee KSK, Conigrave JH, Dobbins TA, Hummerston B, Wilson S, Haber PS, Gray D, Conigrave KM. Support for Aboriginal health services in reducing harms from alcohol: 2-year service provision outcomes in a cluster randomized trial. Addiction 2022; 117:796-803. [PMID: 34605084 PMCID: PMC9298002 DOI: 10.1111/add.15712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS There is a higher prevalence of unhealthy alcohol use among Indigenous populations, but there have been few studies of the effectiveness of screening and treatment in primary health care. Over 24 months, we tested whether a model of service-wide support could increase screening and any alcohol treatment. DESIGN Cluster-randomized trial with 24-month implementation (12 months active, 12 months maintenance). SETTING Australian Aboriginal Community Controlled primary care services. PARTICIPANTS Twenty-two services (83 032 clients) that use Communicare practice software and see at least 1000 clients annually, randomized to the treatment arm or control arm. INTERVENTION AND COMPARATOR Multi-faceted early support model versus a comparator of waiting-list control (11 services). MEASUREMENTS A record (presence = 1, absence = 0) of: (i) Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening (primary outcome), (ii) any-treatment and (iii) brief intervention. We received routinely collected practice data bimonthly over 3 years (1-year baseline, 1-year implementation, 1-year maintenance). Multi-level logistic modelling was used to compare the odds of each outcome before and after implementation. FINDINGS The odds of being screened within any 2-month reference period increased in both arms post-implementation, but the increase was nearly eight times greater in early-support services [odds ratio (OR) = 7.95, 95% confidence interval (CI) = 4.04-15.63, P < 0.001]. The change in odds of any treatment in early support was nearly double that of waiting-list controls (OR = 1.89, 95% CI = 1.19-2.98, P = 0.01) but was largely driven by decrease in controls. There was no clear evidence of difference between groups in the change in the odds of provision of brief intervention (OR = 1.95, 95% CI = 0.53-7.17, P = 0.32). CONCLUSIONS An early support model designed to aid routine implementation of alcohol screening and treatment in Aboriginal health services resulted in improvement of Alcohol Use Disorders Identification Test-Consumption screening rates over 24 months of implementation, but the effect on treatment was less clear.
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Affiliation(s)
- Monika Dzidowska
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthWAAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVICAustralia
| | - James H. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - Timothy A. Dobbins
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Beth Hummerston
- Aboriginal Health Council of South AustraliaAdelaideSAAustralia
| | - Scott Wilson
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- Aboriginal Drug and Alcohol Council (SA) Aboriginal CorporationAdelaideSAAustralia
| | - Paul S. Haber
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
| | - Dennis Gray
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthWAAustralia
| | - Katherine M. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and AlcoholUniversity of SydneySydneyNSWAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Drug Health ServicesRoyal Prince Alfred Hospital (KGV)CamperdownNSWAustralia
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11
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Johnston B. Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use. J Am Psychiatr Nurses Assoc 2022; 28:76-90. [PMID: 34340569 DOI: 10.1177/10783903211036494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening for harmful alcohol use (HAU) is standard in clinical settings; however, self-reports of the quantity/frequency of use are often inconsistent with population survey data and objective assessment. Inaccuracies of self-reported alcohol use prompt exploration of patients' reluctance to share this information with their health care providers. OBJECTIVES The purpose of this article is to identify the assumptions and biases that affect screening and brief interventions for HAU. METHOD A total of 22 research articles were selected for a systematic review of the literature. The studies included prospective and retrospective studies, randomized controlled trials, case studies, and quantitative and qualitative research from 2015 to 2021. RESULTS This systematic review identified alcohol health literacy, the inherent bias of surveys and screening tools, stigma, avoidance bias, and the normalization/villainization of alcohol use as contributors to the assumptions and biases that affect screening and brief interventions for HAU. CONCLUSIONS Exploring these assumptions and biases presents opportunities to develop strategies that promote positive change.
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Affiliation(s)
- Brenda Johnston
- Brenda Johnston, DNP, PMHNP, PMHCNS, Shepherd University School of Nursing, Shepherdstown, WV, USA
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12
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Lu Y, Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Metz VE, Weisner C, Satre DD, Campbell CI, Elson J, Ross TB, Awsare SV, Sterling SA. Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care. Alcohol Clin Exp Res 2021; 45:2179-2189. [PMID: 34486124 DOI: 10.1111/acer.14702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors. METHODS This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017. RESULTS We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions. CONCLUSIONS These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.
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Affiliation(s)
- Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joseph Elson
- The Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sameer V Awsare
- The Permanente Medical Group, TPMG Executive Offices, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
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13
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Grottenthaler JM, Konzelmann A, Stiegler A, Hinterleitner C, Bott SM, Klag T, Werner CR, Hinterleitner M, Königsrainer A, Batra A, Malek NP, Nadalin S, Berg CP. Significance and clinical impact of routinely tested urinary ethyl glucuronide after liver transplantation - development of a risk score. Transpl Int 2021; 34:2257-2265. [PMID: 34358363 DOI: 10.1111/tri.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Alcohol abuse after liver transplantation can seriously impact graft and patient survival. However, to date, there is no defined standard procedure to identify patients consuming alcohol after liver transplantation. The aim of this study was to analyze the diagnostic value and clinical impact of routinely measured urinary ethyl glucuronide (uEtG) - a metabolite of ethanol - in patients after liver transplantation. METHODS Data of 362 consecutive patients after liver transplantation who visited the University Hospital of Tuebingen for outpatient follow-up were analyzed. RESULTS 48 patients (13%) displayed positive uEtG results. The uEtG positive group contained significantly more patients with pre transplant alcoholic liver disease. However, two thirds of the uEtG positive patients had no history of pre transplant alcoholic liver disease. Several clinical parameters were significantly associated with positive uEtG. In order to enable a more cost-effective application of uEtG in the future, a clinical risk score was developed (specificity 0.95). CONCLUSIONS Routine testing for uEtG reveals a considerable percentage of patients practicing alcohol intake after liver transplantation. Application of our proposed risk score could help focusing uEtG testing on patients at risk.
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Affiliation(s)
- Julia M Grottenthaler
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Annette Konzelmann
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Anette Stiegler
- Department of Psychiatry and Psychotherapy, Section Addiction Medicine and Addiction Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Clemens Hinterleitner
- Department of Medical Oncology and Pneumology, University Hospital Tuebingen, Tuebingen, Germany
| | - Sarah M Bott
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Klag
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph R Werner
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Martina Hinterleitner
- Department of Medical Oncology and Pneumology, University Hospital Tuebingen, Tuebingen, Germany
| | - Alfred Königsrainer
- Department of General-, Visceral- and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, Section Addiction Medicine and Addiction Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Nisar P Malek
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Silvio Nadalin
- Department of General-, Visceral- and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph P Berg
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
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14
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Shenvi CL, Weaver MA, Biese KJ, Wang Y, Revankar R, Fatade Y, Aylward A, Busby‐Whitehead J, Platts‐Mills TF, D'Onofrio G. Identification and characterization of older emergency department patients with high-risk alcohol use. J Am Coll Emerg Physicians Open 2020; 1:804-811. [PMID: 33145524 PMCID: PMC7593462 DOI: 10.1002/emp2.12196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/31/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High-risk alcohol use in the elderly is a common but underrecognized problem. We tested a brief screening instrument to identify high-risk individuals. METHODS This was a prospective, cross-sectional study conducted at a single emergency department. High-risk alcohol use was defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines as >7 drinks/week or >3 drinks/occasion. We assessed alcohol use in patients aged ≥ 65 years using the timeline follow back (TLFB) method as a reference standard and a new, 2-question screener based on NIAAA guidelines. The Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed, Guilty, Eye-opener (CAGE) screens were used for comparison. We collected demographic information from a convenience sample of high- and low-risk drinkers. RESULTS We screened 2250 older adults and 180 (8%) met criteria for high-risk use. Ninety-eight high-risk and 124 low-risk individuals were enrolled. The 2-question screener had sensitivity of 98% (95% CI, 93%-100%) and specificity of 87% (95% CI, 80%-92%) using TLFB as the reference. It had higher sensitivity than the AUDIT or CAGE tools. The high-risk group was predominantly male (65% vs 35%, P < 0.001). They drank a median of 14 drinks per week across all ages from 65 to 92. They had higher rates of prior substance use treatment (17% vs 2%, P < 0.001) and current tobacco use (24% vs 9%, P = 0.004). CONCLUSION A rapid, 2-question screener can identify high-risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment.
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Affiliation(s)
- Christina L. Shenvi
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Mark A. Weaver
- Department of Mathematics and StatisticsElon UniversityElonNorth CarolinaUSA
| | - Kevin J. Biese
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Yushan Wang
- Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | | | - Yetunde Fatade
- Department of Internal MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Aileen Aylward
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Jan Busby‐Whitehead
- Division of GeriatricsUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Timothy F. Platts‐Mills
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Gail D'Onofrio
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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15
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Williams EC, Bobb JF, Lee AK, Ludman EJ, Richards JE, Hawkins EJ, Merrill JO, Saxon AJ, Lapham GT, Matson TE, Chavez LJ, Caldeiro R, Greenberg DM, Kivlahan DR, Bradley KA. Effect of a Care Management Intervention on 12-Month Drinking Outcomes Among Patients With and Without DSM-IV Alcohol Dependence at Baseline. J Gen Intern Med 2019:10.1007/s11606-019-05261-7. [PMID: 31432438 DOI: 10.1007/s11606-019-05261-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/24/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The CHOICE care management intervention did not improve drinking relative to usual care (UC) for patients with frequent heavy drinking at high risk of alcohol use disorders. Patients with alcohol dependence were hypothesized to benefit most. We conducted preplanned secondary analyses to test whether the CHOICE intervention improved drinking relative to UC among patients with and without baseline DSM-IV alcohol dependence. METHODS A total of 304 patients reporting frequent heavy drinking from 3 VA primary care clinics were randomized (stratified by DSM-IV alcohol dependence, sex, and site) to UC or the patient-centered, nurse-delivered, 12-month CHOICE care management intervention. Primary outcomes included percent heavy drinking days (%HDD) using 28-day timeline follow-back and a "good drinking outcome" (GDO)-abstaining or drinking below recommended limits and no alcohol-related symptoms on the Short Inventory of Problems at 12 months. Generalized estimating equation binomial regression models (clustered on provider) with interaction terms between dependence and intervention group were fit. RESULTS At baseline, 59% of intervention and UC patients had DSM-IV alcohol dependence. Mean drinking outcomes improved for all subgroups. For participants with dependence, 12-month outcomes did not differ for intervention versus UC patients (%HDD 37% versus 38%, p = 0.76 and GDO 16% versus 16%, p = 0.77). For participants without dependence, %HDD did not differ between intervention (41%) and UC (31%) patients (p = 0.12), but the proportion with GDO was significantly higher among UC participants (26% versus 13%, p = 0.046). Neither outcome was significantly modified by dependence (interaction p values 0.19 for %HDD and 0.10 for GDO). CONCLUSIONS Among participants with frequent heavy drinking, care management had no benefit relative to UC for patients with dependence, but UC may have had benefits for those without dependence. TRIAL REGISTRATION ClinicalTrials.gov NCT01400581.
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Affiliation(s)
- Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- Department of Health Services, University of Washington, Seattle, USA.
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Evette J Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Julie E Richards
- Department of Health Services, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Eric J Hawkins
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | | | - Andrew J Saxon
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Gwen T Lapham
- Department of Health Services, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Theresa E Matson
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, USA
| | | | - Ryan Caldeiro
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
- Kaiser Permanente Washington, Seattle, USA
| | | | - Daniel R Kivlahan
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Katharine A Bradley
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
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16
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Bromberg JR, Spirito A, Chun T, Mello MJ, Casper TC, Ahmad F, Bajaj L, Brown KM, Chernick LS, Cohen DM, Fein J, Horeczko T, Levas MN, McAninch B, Monuteaux M, Mull CC, Grupp-Phelan J, Powell EC, Rogers A, Shenoi RP, Suffoletto B, Vance C, Linakis JG; Pediatric Emergency Care Applied Research Network. Methodology and Demographics of a Brief Adolescent Alcohol Screen Validation Study. Pediatr Emerg Care 2019; 35:737-44. [PMID: 29112110 DOI: 10.1097/PEC.0000000000001221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample characteristics, and baseline outcomes of the NIAAA 2-question screen. METHODS Participants included 12- to 17-year-olds treated in one of the participating pediatric emergency departments across the United States. After enrollment, a criterion assessment battery including the NIAAA 2-question screen and other measures of alcohol, drug use, and risk behavior was self-administered by participants on a tablet computer. Two subsamples were derived from the sample. The first subsample was readministered the NIAAA 2-question screen 1 week after their initial visit to assess test-retest reliability. The second subsample is being reassessed at 12 and 24 months to examine predictive validity of the NIAAA 2-question screen. RESULTS There were 4834 participants enrolled into the study who completed baseline assessments. Participants were equally distributed across sex and age. Forty-six percent of the participants identified as white, and 26% identified as black. Approximately one quarter identified as Hispanic. Using the NIAAA 2-question screen algorithm, approximately 8% were classified as low risk, 12% were classified as moderate risk, and 4% were classified as highest risk. Alcohol use was less likely to be reported by black participants, non-Hispanic participants, and those younger than 16 years. DISCUSSION This study successfully recruited a large, demographically diverse sample to establish rates of the NIAAA screen risk categories across age, sex, ethnicity, and race within pediatric emergency departments.
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17
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Linakis JG, Bromberg JR, Casper TC, Chun T, Mello MJ, Ingebretsen H, Spirito A. Reliability and Validity of the Newton Screen for Alcohol and Cannabis Misuse in a Pediatric Emergency Department Sample. J Pediatr 2019; 210:154-160.e1. [PMID: 30967250 PMCID: PMC6592736 DOI: 10.1016/j.jpeds.2019.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up. STUDY DESIGN Adolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure. RESULTS The sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis. CONCLUSIONS The Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment.
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Affiliation(s)
- James G. Linakis
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | - Julie R. Bromberg
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | | | - Thomas Chun
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | - Michael J. Mello
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | | | - Anthony Spirito
- The Warren Alpert Medical School of Brown University, Providence, RI
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18
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Abstract
This study examined cutoff scores on the new (2014) US-AUDIT (Alcohol Use Disorders Identification Test), adapted for U.S. standard drinks. No studies have examined optimal cutoff scores on the US-AUDIT for college students. 250 undergraduates (65% men) completed the US-AUDIT. At-risk drinkers reported at least four binge drinking episodes per week. Likely alcohol use disorder was assessed with a self-report diagnostic measure. Using the Youden method, the ideal cutoff to identify at-risk drinkers for the US-AUDIT was 5 for men (sensitivity = .93, specificity = .96) and 6 for women (sensitivity = .77, specificity = .86); and to identify likely alcohol use disorder was 13 for men (sensitivity = .69, specificity = .81) and 8 for women (sensitivity = .83, specificity = .80). Cutoffs were lower than the original AUDIT. Different US-AUDIT cutoffs for men and women should be used for likely alcohol use disorder, which may reflect differences in drinking quantity and frequency. Empirical guidelines for alcohol screening with the new US-AUDIT may be used to enhance research or identification of at-risk drinkers in college settings, or for college students in primary care or other health care settings.
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Affiliation(s)
- Brian E McCabe
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL
| | - Ahnalee M Brincks
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Valerie Halstead
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL
| | | | - Ashley Falcon
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL
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Howlett H, Mackenzie S, Strehle EM, Rankin J, Gray WK. A Survey of Health Care Professionals' Knowledge and Experience of Foetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy. Clin Med Insights Reprod Health 2019; 13:1179558119838872. [PMID: 30944523 PMCID: PMC6437318 DOI: 10.1177/1179558119838872] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/27/2019] [Indexed: 01/18/2023]
Abstract
Background Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood.
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Affiliation(s)
- Helen Howlett
- Department of Research and Development, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Shonag Mackenzie
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Eugen-Matthias Strehle
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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20
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Zaidi Touis L, Bolbrinker J, Riemer TG, Kreutz R. Moderation of alcohol consumption as a recommendation in European hypertension management guidelines: a survey on awareness, screening and implementation among European physicians. BMJ Open 2018; 8:e022026. [PMID: 30344170 PMCID: PMC6196817 DOI: 10.1136/bmjopen-2018-022026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Moderation of alcohol consumption is included as a class I, level of evidence A recommendation in the current European guidelines for the management of hypertension. We investigated its awareness and self-reported implementation among European physicians across different specialties and workplaces. DESIGN AND SETTING A cross-sectional survey study conducted in two annual German meetings (German Society of Cardiology and the German Society of Internal Medicine) and two annual European meetings (European Society of Hypertension and European Society Cardiology) in 2015. PARTICIPANTS 1064 physicians attending the European meetings were interviewed including 52.1% cardiologists, 29.2% internists and 8.8% general practitioners. MAIN OUTCOME MEASURES Physician screening of alcohol consumption, awareness and self-implementation of the recommendation of the current European guidelines about moderation of alcohol consumption for the management of hypertension. RESULTS Overall, 81.9% of physicians reported to generally quantify alcohol consumption in patients with hypertension. However, only 28.6% and 14.5% of participants reported screening alcohol consumption in their patients with newly detected or treatment-resistant hypertension. Physicians recommended a maximum alcohol intake of 13.1±11.7 g/day for women (95% CI 12.3 to 13.8) and 19.9±15.6 g/day for men (95% CI 18.8 to 20.9). In case of moderate to high alcohol consumption, 10.3% would manage only hypertension without addressing alcohol consumption, while 3.7% of the physicians would do so in case of alcohol dependence (p<0.001). CONCLUSIONS The average amount of alcohol intake per day recommended by European physicians in this survey was in agreement with the guidelines. The low number of physicians that screen for alcohol consumption in patients with newly detected and with treatment-resistant hypertension indicates an important deficit in the management of hypertension.
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Affiliation(s)
- Laila Zaidi Touis
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Juliane Bolbrinker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Thomas Günther Riemer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
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21
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Kuule Y, Dobson AE, Harries AD, Mutahunga B, Stewart AG, Wilkinson E. Screening, Diagnosis, and Management of Patients With Alcohol Use Disorders at Bwindi Community Hospital, Uganda. Front Public Health 2018; 6:148. [PMID: 29881720 PMCID: PMC5978276 DOI: 10.3389/fpubh.2018.00148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: The harmful use of alcohol is a growing global public health concern, with Sub-Saharan Africa at particular risk. A large proportion of adults in Uganda consume alcohol and the country has a high prevalence of alcohol use disorders (AUD), almost double that for the African region as a whole. Bwindi Community Hospital, in rural western Uganda, recently introduced a program of screening, diagnosis and management of AUD and we assessed how this worked. Methods: This was a cross-sectional study in three departments (out-patients, adult in-patients and sexual & reproductive health) of Bwindi Community Hospital assessing numbers of patients screened, diagnosed and treated with AUD between January 2014 and June 2017. Data sources included the hospital electronic data base and departmental case files. Frequencies and proportions are reported and odds ratios used to compare specific factors associated with medical interventions. Results: Altogether, 82,819 patients attended or were admitted to hospital, of whom 8,627 (10.4%) were screened and 273 (3.2%) diagnosed with AUD. The adult in-patient department recorded the largest number with AUD (n = 206) as well as a consistent increase in numbers in the last 18 months of the study. Of those with AUD, there were 230 (84%) males, 130 (48%) aged 36–60 years, and 131 (48%) with medical non-alcohol related diagnostic categories. Medical/supportive interventions included guidance and counselling to 168 (62%), community social support to 90 (33%), mental health service referrals for 75 (27%), detoxification for 60 (22%) and referral to Alcoholics Anonymous for 41 (15%). There were 36 (15%) patients who received no medical/supportive interventions, with significantly higher proportions in patients with surgical alcohol-related disease and pregnancy-related conditions (P < 0.05). Conclusion: Bwindi Community Hospital has implemented a program for AUD in three departments, with most individuals screened and managed in the adult in-patient department. While a variety of interventions were given to those with AUD, 15% received no intervention and this deficiency must be addressed. Program performance could improve through better screening processes, ensuring that 100% of those with AUD receive a medical/supportive intervention and raising public awareness.
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Affiliation(s)
- Yusufu Kuule
- Church of Uganda, Bwindi Community Hospital, Kanungu, Uganda
| | - Andrew E Dobson
- Church of Uganda, Bwindi Community Hospital, Kanungu, Uganda
| | - Anthony D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Alex G Stewart
- College of Life and Environmental Science, University of Exeter, Exeter, United Kingdom
| | - Ewan Wilkinson
- The Institute of Medicine, University of Chester, Chester, United Kingdom
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22
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Palacio-Vieira J, Segura L, Anderson P, Wolstenholme A, Drummond C, Bendtsen P, Wojnar M, Kaner E, Keurhorst MN, van Steenkiste B, Kłoda K, Mierzecki A, Parkinson K, Newbury-Birch D, Okulicz-Kozaryn K, Deluca P, Colom J, Gual A. Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C. J Eval Clin Pract 2018; 24:369-374. [PMID: 29194899 DOI: 10.1111/jep.12854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVE The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. METHOD From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling. RESULTS Thirty-two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR = 0.56; 95% CI, 0.31-0.99; P < .05). CONCLUSION Although the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.
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Affiliation(s)
- J Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - L Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - P Anderson
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - A Wolstenholme
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - C Drummond
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - P Bendtsen
- Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden
| | - M Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - E Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - M N Keurhorst
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - B van Steenkiste
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - K Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | - A Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | - K Parkinson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | - K Okulicz-Kozaryn
- State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland
| | - P Deluca
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - J Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - A Gual
- Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,Red de Trastornos Adictivos (RETICS), Instituto Carlos III, Madrid, Spain
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23
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Brager J, Rodney T, Finnell D. Informational Videos About Alcohol Use: Feasibility and Acceptability. J Am Psychiatr Nurses Assoc 2018; 24:127-132. [PMID: 28922965 DOI: 10.1177/1078390317731816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An estimated 15.1 million adults ages 18 years and older are classified with an alcohol use disorder, which includes 9.8 million men and 5.3 million women. A brief intervention is indicated for those identified to be at risk because of alcohol use. OBJECTIVE To determine the feasibility and acceptability of informational videos about alcohol use. DESIGN This feasibility study provided participants with the opportunity to choose one of two videos, Alcohol and the Brain or Rethinking Drinking. An online survey was administered to all study participants to identify alcohol-related risk, readiness to decrease use, and knowledge pertaining to alcohol use. RESULTS The two videos provided in this study were feasibly delivered in an on-line format to 129 adults, including 115 males and 5 females identified to be at risk. Knowledge scores increased only slightly. There were mixed results for the readiness scores. CONCLUSIONS Future research should examine the efficacy of these two alcohol brief interventions on alcohol-related outcomes.
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Affiliation(s)
- Jenna Brager
- 1 Jenna Brager, MS, BSN-RN, Johns Hopkins University, Baltimore, MD, USA
| | - Tamar Rodney
- 2 Tamar Rodney, MSN, RN, PMHNP-BC, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah Finnell
- 3 Deborah Finnell, DNS, PMHNP-BC, CARN-AP, FAAN, Johns Hopkins University, Baltimore, MD, USA
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24
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Abstract
This study analyzes the appropriateness of an improved version of one of the most frequently used instruments for the screening of high-risk alcohol consumption. This adaptation was created in accordance with certain limitations recognized by other researchers and in an attempt to adjust the content and scales of some items to a more consensual definition of binge drinking. After revising items 2 and 3, the areas under the ROC curves of the AUDIT and of different abbreviated versions were calculated. A total of 906 minors (468 females) between the ages of 15 and 17 were evaluated. Stratified sampling was conducted on a population of high school students in the city of Valencia (Spain). One school was randomly chosen from each of the city’s 16 school districts. Information was collected on sociodemographic aspects, consumption patterns and the AUDIT containing the improved items. The percentage of underage BD reached 36%, regardless of gender or age. BD groups have been differentiated by different intensity levels, both in males and females. Upon comparing the effectiveness of the distinct versions of the AUDIT, it is recommended that researchers and clinics use the combination of the revised items 2 and 3 to ensure a more precise identification of underage BD. A cut-off point of 5 for this test would permit identification of 94% of the underage BD and would notably reduce false positives.
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Affiliation(s)
| | | | - Patricia Motos-Sellés
- Department of Basic Psychology, Faculty of Psychology, University of ValenciaValencia, Spain
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25
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Bradley KA, Rubinsky AD, Lapham GT, Berger D, Bryson C, Achtmeyer C, Hawkins EJ, Chavez LJ, Williams EC, Kivlahan DR. Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population. Addiction 2016; 111:1975-1984. [PMID: 27349855 DOI: 10.1111/add.13505] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/27/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
AIMS To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). DESIGN Cohort study. SETTING Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention. PARTICIPANTS A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up'). MEASUREMENTS Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up. FINDINGS Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use (P-values all < 0.05). CONCLUSIONS When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. .,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA. .,Group Health Research Institute, Seattle, WA, USA. .,Department of Health Services, University of Washington, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Anna D Rubinsky
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,The Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Gwen T Lapham
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Group Health Research Institute, Seattle, WA, USA
| | - Douglas Berger
- General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher Bryson
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Carol Achtmeyer
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Eric J Hawkins
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Laura J Chavez
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Emily C Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Daniel R Kivlahan
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Symon A, Rankin J, Butcher G, Smith L, Cochrane L. Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study. Acta Obstet Gynecol Scand 2016; 96:53-60. [PMID: 27792241 DOI: 10.1111/aogs.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Heavy episodic ("binge") drinking among women in Scotland is commonplace; prepregnancy drinking is associated with continued antenatal drinking. Evidence for effectiveness of standardized antenatal alcohol assessment is lacking. Alcohol-exposed pregnancies may be missed. We assessed peri-conceptual and mid-pregnancy consumption using a week-long retrospective diary and standard alcohol questionnaires, and evaluated the agreement between these instruments. MATERIAL AND METHODS Cross-sectional study in two Scottish health board areas involving 510 women attending mid-pregnancy ultrasound scan clinics. Face-to-face administration of alcohol retrospective diary and AUDIT or AUDIT-C assessed weekly and daily alcohol consumption levels and patterns. Depression-Anxiety-Stress Scale (DASS-21) assessed maternal wellbeing. A sub-sample (n = 30) provided hair for alcohol metabolite analysis. Pearson's correlation coefficient investigated associations between questionnaires and alcohol metabolite data. RESULTS The response rate was 73.8%. The retrospective diary correlated moderately with AUDIT-C and AUDIT but elicited reports of significantly higher peri-conceptual consumption, (median unit consumption on "drinking days" 6.8; range 0.4-63.8). Additional "special occasions" consumption ranged from 1 to 125 units per week. Correlations between DASS-21 and retrospective diary were weak. Biomarker analysis identified three instances of hazardous peri-conceptual drinking. CONCLUSIONS Women reported higher consumption levels when completing the retrospective diary, especially regarding peri-conceptual "binge" drinking. Routine clinical practice methods may not capture potentially harmful or irregular drinking patterns. Given the association between prepregnancy and antenatal drinking, and alcohol's known teratogenic effects, particularly in the first trimester, the retrospective diary may be a useful low-tech tool to gather information on alcohol intake patterns and levels.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | - Lesley Smith
- Department of Social Work and Public Health, Oxford Brookes University, Oxford, UK
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Whitty M, Nagel T, Ward L, Jayaraj R, Kavanagh D. Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study. Aust N Z J Public Health 2016; 39:216-21. [PMID: 26041086 DOI: 10.1111/1753-6405.12375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/01/2014] [Accepted: 01/01/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals. METHODS Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants. RESULTS Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified. CONCLUSION Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings. IMPLICATIONS Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.
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Affiliation(s)
- Megan Whitty
- Menzies School of Health Research, Northern Territory.,Charles Darwin University, Northern Territory
| | - Tricia Nagel
- Menzies School of Health Research, Northern Territory.,School of Medicine, Flinders University, South Australia
| | - Linda Ward
- Menzies School of Health Research, Northern Territory
| | - Rama Jayaraj
- Menzies School of Health Research, Northern Territory.,Charles Darwin University, Northern Territory
| | - David Kavanagh
- School of Psychology and Counselling, Queensland University of Technology
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Mertens JR, Chi FW, Weisner CM, Satre DD, Ross TB, Allen S, Pating D, Campbell CI, Lu YW, Sterling SA. Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial. Addict Sci Clin Pract 2015; 10:26. [PMID: 26585638 PMCID: PMC4653951 DOI: 10.1186/s13722-015-0047-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 11/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended alcohol screening and intervention in general medical settings since 2004. Yet less than one in six US adults report health care professionals discussing alcohol with them. Little is known about methods for increasing implementation; different staffing models may be related to implementation effectiveness. This implementation trial compared delivery of alcohol screening, brief intervention and referral to specialty treatment (SBIRT) by physicians versus non-physician providers receiving training, technical assistance, and feedback reports. METHODS The study was a cluster randomized implementation trial (ADVISe [Alcohol Drinking as a Vital Sign]). Within a private, integrated health care system, 54 adult primary care clinics were stratified by medical center and randomly assigned in blocked groups of three to SBIRT by physicians (PCP arm) versus non-physician providers and medical assistants (NPP and MA arm), versus usual care (Control arm). NIH-recommended screening questions were added to the electronic health record (EHR) to facilitate SBIRT. We examined screening and brief intervention and referral rates by arm. We also examined patient-, physician-, and system-level factors affecting screening rates and, among those who screened positive, rates of brief intervention and referral to treatment. RESULTS Screening rates were highest in the NPP and MA arm (51 %); followed by the PCP arm (9 %) and the Control arm (3.5 %). Screening increased over the 12 months after training in the NPP and MA arm but remained stable in the PCP arm. The PCP arm had higher brief intervention and referral rates (44 %) among patients screening positive than either the NPP and MA arm (3.4 %) or the Control arm (2.7 %). Higher ratio of MAs to physicians was related to higher screening rates in the NPP and MA arm and longer appointment times to screening and intervention rates in the PCP arm. CONCLUSION Findings suggest that time frames longer than 12 months may be required for full SBIRT implementation. Screening by MAs with intervention and referral by physicians as needed can be a feasible model for increasing the implementation of this critical and under-utilized preventive health service within currently predominant primary care models. TRIAL REGISTRATION Clinical Trials NCT01135654.
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Affiliation(s)
- Jennifer R Mertens
- Kaiser Permanente Northern California, 1800 Harrison, Oakland, CA, 94612, USA.
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Steve Allen
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - David Pating
- The Permanente Medical Group, Kaiser Northern California, 1201 Fillmore Street, San Francisco, CA, 94115, USA.
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Yun Wendy Lu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
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Williams EC, Achtmeyer CE, Thomas RM, Grossbard JR, Lapham GT, Chavez LJ, Ludman EJ, Berger D, Bradley KA. Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study. J Gen Intern Med 2015; 30:1125-32. [PMID: 25731916 PMCID: PMC4510245 DOI: 10.1007/s11606-015-3248-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/28/2015] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Population-based alcohol screening is recommended in primary care, and increasingly incentivized by policies, yet is challenging to implement. The U.S. Veterans Health Administration (VA) achieved high rates of screening using a national performance measure and associated electronic clinical reminder to prompt and facilitate screening and document results. However, the sensitivity of alcohol screening for identifying unhealthy alcohol use is low in VA clinics. OBJECTIVE We aimed to understand factors that might contribute to low sensitivity of alcohol screening. DESIGN This was an observational, qualitative study. PARTICIPANTS Participants included clinical staff responsible for conducting alcohol screening and nine independently managed primary care clinics of a single VA medical center in the Northwestern U.S. APPROACH Four researchers observed clinical staff as they conducted alcohol screening. Observers took handwritten notes, which were transcribed and coded iteratively. Template analysis identified a priori and emergent themes. KEY RESULTS We observed 72 instances of alcohol screening conducted by 31 participating staff. Observations confirmed known challenges to implementation of care using clinical reminders, including workflow and flexibility limitations. Three themes specific to alcohol screening emerged. First, most observed screening was conducted verbally, guided by the clinical reminder, although some variability in approaches to screening (e.g., paper-based or laminate-based screening) was observed. Second, specific verbal screening practices that might contribute to low sensitivity of clinical screening were identified, including conducting non-verbatim screening and making inferences, assumptions, and/or suggestions to input responses. Third, staff introduced and adapted screening questions to enhance patient comfort. CONCLUSIONS This qualitative study in nine clinics found that implementation of alcohol screening facilitated by a clinical reminder resulted primarily in verbal screening in which questions were not asked vertbatim and were otherwise adapted. Non-verbal approaches to screening, or patient self-administration, may enhance validity and standardization of screening while simultaneously addressing limitations of the clinical reminder and issues related to perceived discomfort.
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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, USA,
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Le KB, Johnson JA, Seale JP, Woodall H, Clark DC, Parish DC, Miller DP. Primary care residents lack comfort and experience with alcohol screening and brief intervention: a multi-site survey. J Gen Intern Med 2015; 30:790-6. [PMID: 25666210 PMCID: PMC4441659 DOI: 10.1007/s11606-015-3184-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Approximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention. OBJECTIVE We aimed to determine primary care residents' current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI). DESIGN This was a multi-site, cross-sectional survey conducted from March 2010 through December 2012. PARTICIPANTS We invited all residents in six primary care residency programs (three internal medicine programs and three family medicine programs) to participate. Of 244 residents, 210 completed the survey (response rate 86 %). MAIN MEASURES Our survey assessed residents' alcohol screening practices (instruments used and frequency of screening), perceived barriers to discussing alcohol, brief intervention content, and self-rated ability to help hazardous drinkers. To determine the quality of brief interventions delivered, we examined how often residents reported including the three key recommended elements of feedback, advice, and goal-setting. KEY RESULTS Most residents (60 %, 125/208) reported "usually" or "always" screening patients for alcohol misuse at the initial clinic visit, but few residents routinely screened patients at subsequent acute-care (17 %, 35/208) or chronic-care visits (33 %, 68/208). Only 19 % (39/210) of residents used screening instruments capable of detecting binge drinking. The most frequently reported barrier to SBI was lack of adequate training (54 %, 108/202), and only 21 % (43/208) of residents felt confident they could help at -risk drinkers. When residents did perform a brief intervention, only 24 % (49/208) "usually" or "always" included the three recommended elements. CONCLUSIONS A minority of residents in this multi-site study appropriately screen or intervene with at-risk alcohol users. To equip residents to effectively address hazardous alcohol use, there is a critical need for educational and clinic interventions to support alcohol-related SBI.
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Affiliation(s)
- Kristy Barnes Le
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA,
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Abstract
OBJECTIVE Alcohol misuse can coexist with and/or contribute to the development of cognitive impairment in the older adult population but continues to be underestimated and undetected in older people. This study aimed to examine the feasibility and acceptability of routine screening for alcohol misuse in a small sample of older people with cognitive impairment receiving services in memory clinics. METHODS This study employed a qualitative and exploratory design, using a convenience sample of individuals attending a memory clinic in England. Ten service users older than 65 with a diagnosis of cognitive impairment (i.e., mild cognitive impairment or dementia) took part in the study. Individuals who met inclusion criteria were invited to take part in an hour-long interview, which included the interviewer administering the alcohol screening tools. Interview transcripts were analyzed using thematic analysis. RESULTS Participants were able to engage with the screening tools and could, with assistance, complete them in a collaborative and timely manner without distress. All participants reported that these tools were acceptable as part of the clinic assessment. Administering the screening tools was not time-consuming or difficult, making their use feasible within the memory clinic setting. While there were some challenges (e.g., arithmetic, recall, language problems), these challenges could be overcome with the aid of the person administering the screening tool using standardized techniques for assessment administration. CONCLUSIONS Routine screening for alcohol misuse in older people with cognitive impairment receiving services in memory clinics is feasible and acceptable. The process of completing alcohol screening tools with older adults receiving services at memory clinics may increase awareness of the potential impact of alcohol on cognitive functioning and provide practitioners with an opportunity to educate service users about the ways that their drinking is affecting their memory. Several techniques to facilitate completion of screening tools were identified. Future research should evaluate the reliability and validity of alcohol screening tools with older people through corroborating screening results with other assessment methods.
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Affiliation(s)
- James Randall-James
- a British Psychological Society, Doctoral Course in Clinical Psychology, University of Hertfordshire , Hatfield , United Kingdom
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Miller PM, Book SW, Thomas S, Smith JP, Randall PK, Randall CL. The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients. J Subst Use 2014; 19:225-228. [PMID: 24982593 DOI: 10.3109/14659891.2013.779756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Drinking motives are thought to be important mediators of the relationship between social anxiety and alcohol use. This project evaluates whether specific drinking motives accurately reflect alcohol dependence. If so, brief questions about drinking motives could serve as valuable alcohol screening tools with socially anxious patients. METHODS This investigation was a secondary analysis of an existing data set of 83 subjects with social anxiety disorder and at-risk alcohol use. The relationship between Drinking Motives Questionnaire (DMQ-R-5) subscales and alcohol dependence was evaluated. RESULTS Coping-Depression was the only subscale that contributed to the unique prediction of a diagnosis of alcohol dependence. Additionally, two items (i.e. "to cheer up when you're in a bad mood" and "to forget painful memories") predicted a diagnosis of alcohol dependence above and beyond their association with each other. CONCLUSIONS Among patients with social anxiety, two specific questions on the DMQ-R-5 could provide a useful screen for health professionals to predict alcohol dependence. It may be fruitful to specifically target the motives of "to cheer up when you're in a bad mood" and "to forget painful memories" when providing advice during brief interventions.
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Affiliation(s)
- Peter M Miller
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Sarah W Book
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Suzanne Thomas
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Joshua P Smith
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Patrick K Randall
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
| | - Carrie L Randall
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street P.O. Box 250861 Charleston, SC 29425
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Bradley KA, Chavez LJ, Lapham GT, Williams EC, Achtmeyer CE, Rubinsky AD, Hawkins EJ, Saitz R, Kivlahan DR. When quality indicators undermine quality: bias in a quality indicator of follow-up for alcohol misuse. Psychiatr Serv 2013; 64:1018-25. [PMID: 23852137 PMCID: PMC3959120 DOI: 10.1176/appi.ps.201200449] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Valid quality indicators are needed to monitor and encourage identification and management of mental health and substance use conditions (behavioral conditions). Because behavioral conditions are frequently underidentified, quality indicators often evaluate the proportion of patients who screen positive for a condition who also have appropriate follow-up care documented. However, these "positive-screen-based" quality indicators of follow-up for behavioral conditions could be biased by differences in the denominator due to differential screening quality ("denominator bias") and could reward identification of fewer patients with the behavioral conditions of interest. This study evaluated denominator bias in the performance of Veterans Health Administration (VHA) networks on a quality indicator of follow-up for alcohol misuse that used the number of patients with positive alcohol screens as the denominator. METHODS Two quality indicators of follow-up for alcohol misuse--a positive-screen-based quality indicator and a population-based quality indicator-were compared among 21 VHA networks by review of 219,119 medical records. RESULTS Results for the two quality indicators were inconsistent. For example, two networks performed similarly on the quality indicators (64.7% and 65.4% follow-up) even though one network identified and documented follow-up for almost twice as many patients (5,411 and 2,899 per 100,000 eligible, respectively). Networks that performed better on the positive-screen-based quality indicator identified fewer patients with alcohol misuse than networks that performed better on the population-based quality indicator (mean 4.1% versus 7.4%, respectively). CONCLUSIONS A positive-screen-based quality indicator of follow-up for alcohol misuse preferentially rewarded networks that identified fewer patients with alcohol misuse.
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Patterson DA, Wolf Adelv Unegv Waya S, Dulmus CN. Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations. Best Pract Ment Health 2012; 8:16-28. [PMID: 24634639 PMCID: PMC3953346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization's internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations.
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Affiliation(s)
- David A Patterson
- David A. Patterson, Silver Wolf (Adelv unegv Waya), PhD, is assistant professor and director of the Native American Center for Wellness Research at the University at Buffalo, State University of New York. Catherine N. Dulmus, PhD, is associate dean for research and director of the Buffalo Center for Social Research at the School of Social Work, University at Buffalo, State University of New York
| | - Silver Wolf Adelv Unegv Waya
- David A. Patterson, Silver Wolf (Adelv unegv Waya), PhD, is assistant professor and director of the Native American Center for Wellness Research at the University at Buffalo, State University of New York. Catherine N. Dulmus, PhD, is associate dean for research and director of the Buffalo Center for Social Research at the School of Social Work, University at Buffalo, State University of New York
| | - Catherine N Dulmus
- David A. Patterson, Silver Wolf (Adelv unegv Waya), PhD, is assistant professor and director of the Native American Center for Wellness Research at the University at Buffalo, State University of New York. Catherine N. Dulmus, PhD, is associate dean for research and director of the Buffalo Center for Social Research at the School of Social Work, University at Buffalo, State University of New York
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Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, Kivlahan DR. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med 2011; 26:299-306. [PMID: 20859699 PMCID: PMC3043188 DOI: 10.1007/s11606-010-1509-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 07/26/2010] [Accepted: 08/30/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Alcohol screening questionnaires have typically been validated when self- or researcher-administered. Little is known about the performance of alcohol screening questionnaires administered in clinical settings. OBJECTIVE The purpose of this study was to compare the results of alcohol screening conducted as part of routine outpatient clinical care in the Veterans Affairs (VA) Health Care System to the results on the same alcohol screening questionnaire completed on a mailed survey within 90 days and identify factors associated with discordant screening results. DESIGN Cross sectional. PARTICIPANTS A national sample of 6,861 VA outpatients (fiscal years 2007-2008) who completed the AUDIT-C alcohol screening questionnaire on mailed surveys (survey screen) within 90 days of having clinical AUDIT-C screening documented in their medical records (clinical screen). MAIN MEASURES Alcohol screening results were considered discordant if patients screened positive (AUDIT-C ≥ 5) on either the clinical or survey screen but not both. Multivariable logistic regression was used to estimate the prevalence of discordance in different patient subgroups based on demographic and clinical characteristics, VA network and temporal factors (e.g. the order of screens). KEY RESULTS Whereas 11.1% (95% CI 10.4-11.9%) of patients screened positive for unhealthy alcohol use on the survey screen, 5.7% (5.1- 6.2%) screened positive on the clinical screen. Of 765 patients who screened positive on the survey screen, 61.2% (57.7-64.6%) had discordant results on the clinical screen, contrasted with 1.5% (1.2-1.8%) of 6096 patients who screened negative on the survey screen. In multivariable analyses, discordance was significantly increased among Black patients compared with White, and among patients who had a positive survey AUDIT-C screen or who received care at 4 of 21 VA networks. CONCLUSION Use of a validated alcohol screening questionnaire does not-by itself-ensure the quality of alcohol screening. This study suggests that the quality of clinical alcohol screening should be monitored, even when well-validated screening questionnaires are used.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
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Bradley KA, Rubinsky AD, Sun H, Bryson CL, Bishop MJ, Blough DK, Henderson WG, Maynard C, Hawn MT, Tønnesen H, Hughes G, Beste LA, Harris AHS, Hawkins EJ, Houston TK, Kivlahan DR. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery. J Gen Intern Med 2011; 26:162-9. [PMID: 20878363 PMCID: PMC3019325 DOI: 10.1007/s11606-010-1475-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed. OBJECTIVE To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire-up to a year before surgery-were associated with the risk of postoperative complications. DESIGN This is a cohort study. SETTING AND PARTICIPANTS Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA's Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery. MAIN OUTCOME MEASURE One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews. RESULTS Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8-6.6%) in patients with AUDIT-C scores 1-4, to 7.9% (6.3-9.7%) in patients with AUDIT-Cs 5-8, 9.7% (6.6-14.1%) in patients with AUDIT-Cs 9-10 and 14.0% (8.9-21.3%) in patients with AUDIT-Cs 11-12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1-5.7%) in patients with AUDIT-C scores 1-4, to 6.9% (5.5-8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0-11.3%) among those with AUDIT-Cs 9-10. CONCLUSIONS AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA 98101, USA.
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Patterson DA, Wolf Adelv Unegv Waya S, McKiernan PM. Organizational and clinical implications of integrating an alcohol screening and brief intervention within non-substance abuse serving agencies. J Evid Based Soc Work 2010; 7:332-47. [PMID: 20799131 PMCID: PMC3519141 DOI: 10.1080/15433710903256880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although there have been efforts to advance evidenced-based practices into community-based organizations the limited successes of dissemination and poor implementation of efficacious treatments within these organizations are beginning to be documented. This article builds on the knowledge gained from organizational research and those internal structures (e.g., culture and climate), which possibly impede or enhance evidenced-based practice implementation within community-based organizations. While there are many evidenced-based practices available to human services organizations, there seems to be a gap between research and the implementation of these clinical practices. Recommendations are provided to better enable community-based organizations to integrate evidenced-based practice into its existing service structures.
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Affiliation(s)
- David A Patterson
- School of Social Work, University at Buffalo, SUNY, Buffalo, New York 14260-1050, USA.
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Rubinsky AD, Kivlahan DR, Volk RJ, Maynard C, Bradley KA. Estimating risk of alcohol dependence using alcohol screening scores. Drug Alcohol Depend 2010; 108:29-36. [PMID: 20042299 PMCID: PMC2835806 DOI: 10.1016/j.drugalcdep.2009.11.009] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 08/26/2009] [Accepted: 11/07/2009] [Indexed: 12/16/2022]
Abstract
Brief alcohol counseling interventions can reduce alcohol consumption and related morbidity among non-dependent risky drinkers, but more intensive alcohol treatment is recommended for persons with alcohol dependence. This study evaluated whether scores on common alcohol screening tests could identify patients likely to have current alcohol dependence so that more appropriate follow-up assessment and/or intervention could be offered. This cross-sectional study used secondary data from 392 male and 927 female adult family medicine outpatients (1993-1994). Likelihood ratios were used to empirically identify and evaluate ranges of scores of the AUDIT, the AUDIT-C, two single-item questions about frequency of binge drinking, and the CAGE questionnaire for detecting DSM-IV past-year alcohol dependence. Based on the prevalence of past-year alcohol dependence in this sample (men: 12.2%; women: 5.8%), zones of the AUDIT and AUDIT-C identified wide variability in the post-screening risk of alcohol dependence in men and women, even among those who screened positive for alcohol misuse. Among men, AUDIT zones 5-10, 11-14 and 15-40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 18 to 87%, and AUDIT-C zones 5-6, 7-9 and 10-12 were associated with probabilities ranging from 22 to 75%. Among women, AUDIT zones 3-4, 5-8, 9-12 and 13-40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 6 to 94%, and AUDIT-C zones 3, 4-6, 7-9 and 10-12 were associated with probabilities ranging from 9 to 88%. AUDIT or AUDIT-C scores could be used to estimate the probability of past-year alcohol dependence among patients who screen positive for alcohol misuse and inform clinical decision-making.
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Affiliation(s)
- Anna D Rubinsky
- Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98101, USA.
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Rose GL, MacLean CD, Skelly J, Badger GJ, Ferraro TA, Helzer JE. Interactive voice response technology can deliver alcohol screening and brief intervention in primary care. J Gen Intern Med 2010; 25:340-4. [PMID: 20127196 DOI: 10.1007/s11606-009-1233-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 12/03/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alcohol screening and brief intervention (BI) is an effective primary care preventive service, but implementation rates are low. Automating BI using interactive voice response (IVR) may be an efficient way to expand patient access to needed information and advice. OBJECTIVE To develop IVR-based BI and pilot test it for feasibility and acceptability. DESIGN Single-group pre-post feasibility study. PARTICIPANTS Primary care patients presenting for an office visit. INTERVENTIONS IVR-BI structured to correspond to the provider BI method recommended by NIAAA: (1) Ask about use; (2) Assess problems; (3) Advise and Assist for change, and (4) Follow up for continued support. Advice was tailored to patient readiness and preferences. MEASUREMENTS Utilization rate, call duration, and patients' subjective reports of usefulness, comfort and honesty with the IVR-BI. Pre-post evaluation of motivation to change and change in alcohol consumption as measured by Timeline Follow Back. RESULTS Call duration ranged from 3-7 minutes. Subjective reactions were generally positive or neutral. About 40% of subjects indicated IVR-BI had motivated them to change. About half of the patients had discussed drinking with their provider at the visit. These tended to be heavier drinkers with greater concerns about drinking. Patients who reported a provider-delivered BI and called the IVR-BI endorsed greater comfort and honesty with the IVR-BI. On average, a 25% reduction in alcohol use was reported two weeks after the clinic visit. CONCLUSIONS Using IVR technology to deliver BI in a primary care setting is feasible and data suggest potential for efficacy in a larger trial.
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Bernstein E, Bernstein J, Feldman J, Fernandez W, Hagan M, Mitchell P, Safi C, Woolard R, Mello M, Baird J, Lee C, Bazargan-Hejazi S, Broderick K, Laperrier KA, Kellermann A, Wald MM, Taylor RE, Walton K, Grant-Ervin M, Rollinson D, Edwards D, Chan T, Davis D, Buchanan Marshall J, Aseltine R, James A, Schilling E, Abu-Hasaballah K, Baumann BM, Boudreaux ED, Maio RF, Cunningham RM, Murrell T, Doezema D, Anglin D, Eliassen A, Martin M, Pines J, Buchanan L, Turner J, D'Onofrio G, Degutis LC, Owens P. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Subst Abus 2007; 28:79-92. [PMID: 18077305 PMCID: PMC3976968 DOI: 10.1300/j465v28n04_01] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. METHODS ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. RESULTS Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. CONCLUSIONS ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.
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Affiliation(s)
- Edward Bernstein
- Department of Emergency Medicine, Boston University School of Medicine, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA.
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