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Johnson KA, McDaniel JT, Okine J, Graham HK, Robertson ET, McIntosh S, Wallace J, Albright DL. A machine learning model for the prediction of unhealthy alcohol use among women of childbearing age in Alabama. Alcohol Alcohol 2024; 59:agad075. [PMID: 37968937 DOI: 10.1093/alcalc/agad075] [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: 07/27/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION This study utilizes a machine learning model to predict unhealthy alcohol use treatment levels among women of childbearing age. METHODS In this cross-sectional study, women of childbearing age (n = 2397) were screened for alcohol use over a 2-year period as part of the AL-SBIRT (screening, brief intervention, and referral to treatment in Alabama) program in three healthcare settings across Alabama for unhealthy alcohol use severity and depression. A support vector machine learning model was estimated to predict unhealthy alcohol use scores based on depression score and age. RESULTS The machine learning model was effective in predicting no intervention among patients with lower Patient Health Questionnaire (PHQ)-2 scores of any age, but a brief intervention among younger patients (aged 18-27 years) with PHQ-2 scores >3 and a referral to treatment for unhealthy alcohol use among older patients (between the ages of 25 and 50) with PHQ-2 scores >4. CONCLUSIONS The machine learning model can be an effective tool in predicting unhealthy alcohol use treatment levels and approaches.
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Affiliation(s)
- Karen A Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - Justin T McDaniel
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - Joana Okine
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - Heather K Graham
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - Ellen T Robertson
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - Shanna McIntosh
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - Juliane Wallace
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
| | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487-0314, United States
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Mintz CM, Knox J, Hartz SM, Hasin DS, Martins SS, Kranzler HR, Greene E, Geng EH, Grucza RA, Bierut LJ. Demographic differences in the cascade of care for unhealthy alcohol use: A cross-sectional analysis of data from the 2015-2019 National Survey on Drug Use and Health. Alcohol Clin Exp Res (Hoboken) 2023; 47:1890-1903. [PMID: 37864538 PMCID: PMC10590988 DOI: 10.1111/acer.15176] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The screening, brief intervention, and referral to treatment (SBIRT) model is recommended by the U.S. Preventive Services Task Force to improve recognition of and intervention for unhealthy alcohol use. How SBIRT implementation differs by demographic characteristics is poorly understood. METHODS We analyzed data from the 2015-2019 National Survey on Drug Use and Health from respondents ≥18 years old who used an outpatient clinic and had at least one alcoholic drink within the past year. Respondents were grouped into one of three mutually exclusive groups: "no binge drinking or alcohol use disorder (AUD)," "binge drinking without AUD," or "AUD." Outcome variables were likelihood of screening, brief intervention (BI), referral to treatment (RT), and AUD treatment. The demographic predictors on which outcomes were regressed included gender, age, race and ethnicity, sexual orientation, insurance status, and history of military involvement. Consistent with SBIRT guidelines, the entire sample was included in the screening model; screened persons with either binge drinking without AUD or with AUD were included in the BI model; screened persons with AUD were included in the RT model, and persons referred to treatment with AUD were included in the AUD treatment model. RESULTS Analyses included 120,804 respondents. Women were more likely than men to be screened, but less likely to receive BI or RT. When referred to treatment, women were more likely than men to receive it. Persons aged ≥50 were least likely to be screened about alcohol, but most likely to receive BI, while persons aged 18-25 were least likely to receive BI or AUD treatment. Racial and ethnic minorities were less likely than White persons to be screened; Asians were less likely to receive RT, and Black persons were less likely to receive treatment than White persons. Persons identifying as gay, lesbian, or bisexual were equally as likely or more likely to receive SBIRT or AUD treatment as those identifying as heterosexual. Persons without insurance were less likely to be screened than those with insurance. Persons with a history of military involvement were more likely to be screened and receive BI and RT than persons who had not served in the military. CONCLUSIONS Demographic disparities in SBIRT implementation exist. Addressing the sources of these disparities and minimizing attrition from care could improve outcomes for persons with unhealthy alcohol use.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Emily Greene
- Physician Assistant Program, The City College of New York School of Medicine, New York, New York, USA
| | - Elvin H. Geng
- Department of Medicine, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Richard A. Grucza
- Department of Family Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
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Krist AH, Huffstetler AN, Villalobos G, Rockwell MS, Richards A, Funk A, Sabo RT, Bortz B, Webel B, Lee JH, Russel K, Kuzel A, Britz JB, Moeller FG. Use of population health data to promote equitable recruitment for a primary care practice implementation trial addressing unhealthy alcohol use. J Clin Transl Sci 2023; 7:e110. [PMID: 37250994 PMCID: PMC10225269 DOI: 10.1017/cts.2023.530] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Recruiting underrepresented people and communities in research is essential for generalizable findings. Ensuring representative participants can be particularly challenging for practice-level dissemination and implementation trials. Novel use of real-world data about practices and the communities they serve could promote more equitable and inclusive recruitment. Methods We used a comprehensive primary care clinician and practice database, the Virginia All-Payers Claims Database, and the HealthLandscape Virginia mapping tool with community-level socio-ecological information to prospectively inform practice recruitment for a study to help primary care better screen and counsel for unhealthy alcohol use. Throughout recruitment, we measured how similar study practices were to primary care on average, mapped where practices' patients lived, and iteratively adapted our recruitment strategies. Results In response to practice and community data, we adapted our recruitment strategy three times; first leveraging relationships with residency graduates, then a health system and professional organization approach, followed by a community-targeted approach, and a concluding approach using all three approaches. We enrolled 76 practices whose patients live in 97.3% (1844 of 1907) of Virginia's census tracts. Our overall patient sample had similar demographics to the state for race (21.7% vs 20.0% Black), ethnicity (9.5% vs 10.2% Hispanic), insurance status (6.4% vs 8.0% uninsured), and education (26.0% vs 32.5% high school graduate or less). Each practice recruitment approach uniquely included different communities and patients. Discussion Data about primary care practices and the communities they serve can prospectively inform research recruitment of practices to yield more representative and inclusive patient cohorts for participation.
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Affiliation(s)
- Alex H. Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Inova Health System, Fairfax, VA, USA
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Alison N. Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Inova Health System, Fairfax, VA, USA
| | - Gabriela Villalobos
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle S. Rockwell
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam Funk
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T. Sabo
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Beth Bortz
- Virginia Center for Health Innovation, Richmond, VA, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Jong Hyung Lee
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Kyle Russel
- Virginia Health Information, Richmond, VA, USA
| | - Anton Kuzel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaqueline B. Britz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - F. Gerard Moeller
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
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Kane JC, Kamanga M, Skavenski S, Murray LK, Shawa M, Bwalya B, Metz K, Paul R, Mushabati N, Ventevogel P, Haddad S, Kilbane G, Sienkiewicz M, Chibemba V, Chiluba P, Mtongo N, Chibwe M, Figge CJ, Alto M, Mwanza D, Mupinde E, Kakumbi S, Tol WA, Vaughan K, Banda Z, Busse A, Ezard N, Zulu A, Loongo H, Greene MC. Testing a Screening, Brief Intervention, and Referral to Treatment Intervention Approach for Addressing Unhealthy Alcohol and Other Drug Use in Humanitarian Settings: Protocol of the Ukuundapwa Chapamo Randomised Controlled Trial. Intervention (Amstelveen) 2023; 21:58-69. [PMID: 37228642 PMCID: PMC10206531 DOI: 10.4103/intv.intv_21_22] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Refugees and other displaced persons are exposed to many risk factors for unhealthy alcohol and other drug (AOD) use and concomitant mental health problems. Evidence-based services for AOD use and mental health comorbidities are rarely available in humanitarian settings. In high income countries, screening, brief intervention and referral to treatment (SBIRT) systems can provide appropriate care for AOD use but have rarely been used in low- and middle-income countries and to our knowledge never tested in a humanitarian setting. This paper describes the protocol for a randomised controlled trial to compare the effectiveness of an SBIRT system featuring the Common Elements Treatment Approach (CETA) to treatment as usual in reducing unhealthy AOD use and mental health comorbidities among refugees from the Democratic Republic of the Congo and host community members in an integrated settlement in northern Zambia. The trial is an individually randomised, single-blind, parallel design with outcomes assessed at 6-months (primary) and 12-months post-baseline. Participants are Congolese refugees and Zambians in the host community, 15 years of age or older with unhealthy alcohol use. Outcomes are: unhealthy alcohol use (primary), other drug use, depression, anxiety and traumatic stress. The trial will explore SBIRT acceptability, appropriateness, cost-effectiveness, feasibility, and reach.
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Affiliation(s)
- Jeremy C. Kane
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Muzi Kamanga
- Women in Law and Development in Africa, Lusaka, Zambia
| | | | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mbaita Shawa
- Women in Law and Development in Africa, Lusaka, Zambia
| | | | - Kristina Metz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ravi Paul
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Stephanie Haddad
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Grace Kilbane
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Megan Sienkiewicz
- Columbia University Mailman School of Public Health, New York, New York, USA
| | | | | | - Nkumbu Mtongo
- Women in Law and Development in Africa, Lusaka, Zambia
| | | | - Caleb J. Figge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Mwanza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Mupinde
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shira Kakumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse A. Tol
- University of Copenhagen, Copenhagen, Denmark
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Anja Busse
- United Nations Office on Drug Use and Crime, Vienna, Austria
| | - Nadine Ezard
- University of New South Wales, Sydney, Australia
| | | | | | - M. Claire Greene
- Columbia University Mailman School of Public Health, New York, New York, USA
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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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Gómez-Restrepo C, Cepeda M, Torrey WC, Suarez-Obando F, Uribe-Restrepo JM, Park S, Acosta MPJ, Camblor PM, Castro SM, Aguilera-Cruz J, González L, Chaparro N, Gómez-Gamez AM, Bell K, Marsch LA. Perceived access to general and mental healthcare in primary care in Colombia during COVID-19: A cross-sectional study. Front Public Health 2022; 10:896318. [PMID: 36159257 PMCID: PMC9490130 DOI: 10.3389/fpubh.2022.896318] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/19/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The COVID-19 pandemic has had an impact both in general and mental healthcare, challenged the health systems worldwide, and affected their capacity to deliver essential health services. We aimed to describe perceived changes in ease of access to general and mental healthcare among patients with a diagnosis of depression and/or unhealthy alcohol use in Colombia. Methods This study is embedded in the DIADA project, a multicenter implementation research study aimed at evaluating the integration of mental healthcare in primary care in Colombia. Between November 2020 and August 2021, we conducted a COVID-19 pandemic impact assessment in a cohort of participants with newly diagnosed depression and/or unhealthy alcohol use part of DIADA project. We assessed the ease of access and factors related to perceived ease of access to general or mental healthcare, during the COVID-19 pandemic. Results 836 participants completed the COVID-19 pandemic impact assessment. About 30% of participants considered their mental health to be worse during the pandemic and 84.3% perceived access to general healthcare to be worse during the pandemic. Most of participants (85.8%) were unable to assess access to mental health services, but a significant proportion considered it to be worse. Experiencing worse ease of access to general healthcare was more frequent among women, patients with diagnosis of depression, and patients with comorbidities. Experiencing worse ease of access to mental healthcare was more frequent among patients aged between 30 and 49.9 years, from socioeconomic status between 4 and 6, affiliated to the contributive social security regime, attending urban study sites, and those who perceived their mental health was worse during the pandemic. Discussion Despite the overall perception of worse mental health during the pandemic, the use of mental healthcare was low compared to general healthcare. Ease of access was perceived to be worse compared to pre-pandemic. Ease of access and access were affected by geographical study site, socioeconomic status, age and gender. Our findings highlight the need for improved communication between patients and institutions, tailored strategies to adapt the healthcare provision to patients' characteristics, and continued efforts to strengthen the role of mental healthcare provision in primary care.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia,*Correspondence: Magda Cepeda
| | - William C. Torrey
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | | | | | - Sena Park
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - María Paula Jassir Acosta
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martínez Camblor
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Sergio M. Castro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeny Aguilera-Cruz
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lilian González
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Natalia Chaparro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana María Gómez-Gamez
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
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Karnik NS, Thompson HM, Afshar M. Response to Fitzgerald & Barenholtz: There is still much work to be done for digital classifiers. Addiction 2022; 117:1496. [PMID: 34964190 DOI: 10.1111/add.15788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Niranjan S Karnik
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Hale M Thompson
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Majid Afshar
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, USA
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Lin Y, Sharma B, Thompson HM, Boley R, Perticone K, Chhabra N, Afshar M, Karnik NS. External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients. Addiction 2022; 117:925-933. [PMID: 34729829 PMCID: PMC9296269 DOI: 10.1111/add.15730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/13/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Unhealthy alcohol use (UAU) is one of the leading causes of global morbidity. A machine learning approach to alcohol screening could accelerate best practices when integrated into electronic health record (EHR) systems. This study aimed to validate externally a natural language processing (NLP) classifier developed at an independent medical center. DESIGN Retrospective cohort study. SETTING The site for validation was a midwestern United States tertiary-care, urban medical center that has an inpatient structured universal screening model for unhealthy substance use and an active addiction consult service. PARTICIPANTS/CASES Unplanned admissions of adult patients between October 23, 2017 and December 31, 2019, with EHR documentation of manual alcohol screening were included in the cohort (n = 57 605). MEASUREMENTS The Alcohol Use Disorders Identification Test (AUDIT) served as the reference standard. AUDIT scores ≥5 for females and ≥8 for males served as cases for UAU. To examine error in manual screening or under-reporting, a post hoc error analysis was conducted, reviewing discordance between the NLP classifier and AUDIT-derived reference. All clinical notes excluding the manual screening and AUDIT documentation from the EHR were included in the NLP analysis. FINDINGS Using clinical notes from the first 24 hours of each encounter, the NLP classifier demonstrated an area under the receiver operating characteristic curve (AUCROC) and precision-recall area under the curve (PRAUC) of 0.91 (95% CI = 0.89-0.92) and 0.56 (95% CI = 0.53-0.60), respectively. At the optimal cut point of 0.5, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.66 (95% CI = 0.62-0.69), 0.98 (95% CI = 0.98-0.98), 0.35 (95% CI = 0.33-0.38), and 1.0 (95% CI = 1.0-1.0), respectively. CONCLUSIONS External validation of a publicly available alcohol misuse classifier demonstrates adequate sensitivity and specificity for routine clinical use as an automated screening tool for identifying at-risk patients.
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Affiliation(s)
- Yiqi Lin
- Rush Medical CollegeRush UniversityChicagoILUSA
| | - Brihat Sharma
- Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
| | - Hale M. Thompson
- Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
| | - Randy Boley
- Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
| | | | - Neeraj Chhabra
- Department of Emergency Medicine, Rush Medical CollegeRush UniversityChicagoILUSA,Department of Emergency MedicineJohn. H. Stroger, Jr. Hospital of Cook CountyChicagoILUSA
| | - Majid Afshar
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Niranjan S. Karnik
- Rush Medical CollegeRush UniversityChicagoILUSA,Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
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Livne O, Feinn R, Knox J, Hartwell EE, Gelernter J, Hasin DS, Kranzler HR. Alcohol withdrawal in past-year drinkers with unhealthy alcohol use: Prevalence, characteristics, and correlates in a national epidemiologic survey. Alcohol Clin Exp Res 2022; 46:422-433. [PMID: 35275407 PMCID: PMC8928097 DOI: 10.1111/acer.14781] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/19/2021] [Accepted: 01/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite its potential to produce serious adverse outcomes, DSM-5 alcohol withdrawal syndrome (AWS) has not been widely studied in the general population. METHODS We used cross-sectional data from 36,309 U.S. adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III to examine the past-year prevalence of AWS and its correlates. We focused on an important clinical population-past-year drinkers with unhealthy alcohol use-i.e., those with a positive score on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. We also examined the association of AWS with sociodemographic measures, psychiatric disorders, alcohol-related measures, and healthcare utilization. RESULTS Approximately one-third (n = 12,634) of respondents reported unhealthy alcohol use (AUDIT-C+). Of these, 14.3% met criteria for a DSM-5 AWS diagnosis. The mean (SE) number of withdrawal symptoms among individuals with AWS was 2.83 (1.88), with the most common being nausea/vomiting and insomnia (19.8% and 11.6%, respectively). Among AUDIT-C+ respondents, the odds of AWS were significantly higher among males (adjusted odds ratio [aOR] = 1.17 [95% CI, 1.02-1.33]), unmarried participants (aOR = 1.55 [95% CI, 1.25-1.92]), and those at the lowest (vs. highest) income levels (aOR = 1.62 [95% CI, 1.37-1.92]). Among AUDIT-C+ respondents, AWS was also associated with psychiatric disorders (with aORs that ranged from 2.08 [95% CI, 1.79-2.41]) for major depressive disorder to 3.14 (95% CI, 1.79-2.41) for borderline personality disorder. AUDIT-C+ respondents with AWS also had higher odds of past-year alcohol use disorder (aOR = 11.2 [95% CI, 9.66-13.07]), other alcohol-related features (e.g., binge drinking), and healthcare utilization. CONCLUSIONS Among individuals with unhealthy alcohol use, AWS is prevalent, highly comorbid, and disabling. Given the risk of AWS among unhealthy drinkers, a comparatively large segment of the general population, clinicians should seek to identify individuals with AWS and intervene with them to prevent serious adverse outcomes.
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Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT
| | - Justin Knox
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY,New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY
| | - Emily E. Hartwell
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, West Haven, CT
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Henry R. Kranzler
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA
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10
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Bhalla S, Sharma B, Smith D, Boley R, McCluskey C, Ilyas Y, Afshar M, Balk R, Karnik N, Keshavarzian A. Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study. JMIR Public Health Surveill 2021; 7:e33022. [PMID: 34665758 PMCID: PMC8575002 DOI: 10.2196/33022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19. OBJECTIVE We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk. METHODS In this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status. RESULTS Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95% CI 1.17-3.06), suggesting that UAU was associated with an 89% increase in the odds of being in a higher severity category. CONCLUSIONS In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death.
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Affiliation(s)
- Sameer Bhalla
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Brihat Sharma
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Dale Smith
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Randy Boley
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Connor McCluskey
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Yousaf Ilyas
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Majid Afshar
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Robert Balk
- Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Niranjan Karnik
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Ali Keshavarzian
- Center for Circadian Rhythm and Alcohol-Induced Tissue Injury, Rush University Medical Center, Chicago, IL, United States
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11
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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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12
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Fuster D, Nunes D, Cheng DM, Saitz R, Samet JH. Alcohol Consumption and Hepatitis C Virus (HCV) RNA Levels in HIV/HCV Coinfected Patients. Viruses 2021; 13:716. [PMID: 33919027 DOI: 10.3390/v13050716] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impact of Hepatitis C virus (HCV) RNA levels on the evolution of chronic HCV infection-related liver damage is controversial. Heavy alcohol use is believed to have a deleterious impact on the course of HCV disease, but current knowledge about the possible effect of alcohol use on HCV RNA levels in HIV/HCV coinfected patients is limited. METHODS We examined 107 HIV/HCV-infected individuals with current or past unhealthy alcohol use to assess the association between alcohol consumption (any drinking vs. abstinent) and HCV RNA levels. RESULTS Participants were 75% male, with a mean age of 43 years, and 63% were on antiretroviral therapy. Mean (SD) log HIV RNA was 3.1 (1.4) and mean (SD) log HCV RNA was 6.1 (0.8). Past-month alcohol use was present in 38% of participants. In a multivariable linear regression analysis we found no significant differences in mean log HCV RNA levels between those reporting alcohol use and those who were abstinent [β (95%CI): -0.04 (-0.34, 0.26), p = 0.79)]. There was no significant association between any heavy drinking day and HCV RNA level (0.07, 95% CI: (-0.24, 0.38), p = 0.66). CONCLUSIONS We did not detect significant associations between alcohol use and HCV RNA levels among HIV/HCV coinfected patients.
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13
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Kane JC, Glass N, Bolton PA, Mayeya J, Paul R, Mwenge M, Murray LK. Two-year treatment effects of the common elements treatment approach (CETA) for reducing intimate partner violence and unhealthy alcohol use in Zambia. Glob Ment Health (Camb) 2021; 8:e4. [PMID: 34026235 PMCID: PMC8127632 DOI: 10.1017/gmh.2021.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/16/2020] [Accepted: 01/13/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) and unhealthy alcohol use are common yet often unaddressed public health problems in low- and middle-income countries. In a randomized trial, we found that the common elements treatment approach (CETA), a multi-problem, flexible, transdiagnostic intervention, was effective in reducing IPV and unhealthy alcohol use among couples in Zambia at a 12-month post-baseline assessment. In this follow-up study, we investigated whether treatment effects were sustained among CETA participants at 24-months post-baseline. METHODS Participants were heterosexual couples in Zambia in which the woman reported IPV perpetrated by the male partner and in which the male had hazardous alcohol use. Couples were randomized to CETA or treatment as usual plus safety checks. Measures were the Severity of Violence Against Women Scale (SVAWS) and the Alcohol Use Disorders Identification Test (AUDIT). The trial was stopped early upon recommendation by the trial's DSMB due to CETA's effectiveness following the 12-month assessment. Control participants exited the study and were offered CETA. This brief report presents data from an additional follow-up assessment conducted among original CETA participants at a 24-month visit. RESULTS There were no meaningful changes in SVAWS or AUDIT scores between 12- and 24-months. The within-group treatment effect for SVAWS from baseline to 24-months was d = 1.37 (p < 0.0001) and AUDIT was d = 0.85 (p < 0.0001). CONCLUSIONS The lack of change in levels of IPV and unhealthy alcohol use between the 12- and 24-month post-baseline timepoints suggests that treatment gains were sustained among participants who received CETA for at least two years from intervention commencement.
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Affiliation(s)
- Jeremy C. Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Paul A. Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ravi Paul
- Department of Psychiatry, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mwamba Mwenge
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Palzes VA, Weisner C, Chi FW, Kline-Simon AH, Satre DD, Hirschtritt ME, Ghadiali M, Sterling S. The Kaiser Permanente Northern California Adult Alcohol Registry, an Electronic Health Records-Based Registry of Patients With Alcohol Problems: Development and Implementation. JMIR Med Inform 2020; 8:e19081. [PMID: 32706676 PMCID: PMC7407243 DOI: 10.2196/19081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/26/2023] Open
Abstract
Background Electronic health record (EHR)–based disease registries have aided health care professionals and researchers in increasing their understanding of chronic illnesses, including identifying patients with (or at risk of developing) conditions and tracking treatment progress and recovery. Despite excessive alcohol use being a major contributor to the global burden of disease and disability, no registries of alcohol problems exist. EHR-based data in Kaiser Permanente Northern California (KPNC), an integrated health system that conducts systematic alcohol screening, which provides specialty addiction medicine treatment internally and has a membership of over 4 million members that are highly representative of the US population with access to care, provide a unique opportunity to develop such a registry. Objective Our objectives were to describe the development and implementation of a protocol for assembling the KPNC Adult Alcohol Registry, which may be useful to other researchers and health systems, and to characterize the registry cohort descriptively, including underlying health conditions. Methods Inclusion criteria were adult members with unhealthy alcohol use (using National Institute on Alcohol Abuse and Alcoholism guidelines), an alcohol use disorder (AUD) diagnosis, or an alcohol-related health problem between June 1, 2013, and May 31, 2019. We extracted patients’ longitudinal, multidimensional EHR data from 1 year before their date of eligibility through May 31, 2019, and conducted descriptive analyses. Results We identified 723,604 adult patients who met the registry inclusion criteria at any time during the study period: 631,780 with unhealthy alcohol use, 143,690 with an AUD diagnosis, and 18,985 with an alcohol-related health problem. We identified 65,064 patients who met two or more criteria. Of the 4,973,195 adult patients with at least one encounter with the health system during the study period, the prevalence of unhealthy alcohol use was 13% (631,780/4,973,195), the prevalence of AUD diagnoses was 3% (143,690/4,973,195), and the prevalence of alcohol-related health problems was 0.4% (18,985/4,973,195). The registry cohort was 60% male (n=432,847) and 41% non-White (n=295,998) and had a median age of 41 years (IQR=27). About 48% (n=346,408) had a chronic medical condition, 18% (n=130,031) had a mental health condition, and 4% (n=30,429) had a drug use disorder diagnosis. Conclusions We demonstrated that EHR-based data collected during clinical care within an integrated health system could be leveraged to develop a registry of patients with alcohol problems that is flexible and can be easily updated. The registry’s comprehensive patient-level data over multiyear periods provides a strong foundation for robust research addressing critical public health questions related to the full course and spectrum of alcohol problems, including recovery, which would complement other methods used in alcohol research (eg, population-based surveys, clinical trials).
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Affiliation(s)
- Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, CA, United States
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, CA, United States
| | - Matthew E Hirschtritt
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, CA, United States.,Department of Psychiatry, Kaiser Permanente East Bay, Oakland, CA, United States
| | - Murtuza Ghadiali
- Department of Addiction Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States.,Department of Addiction Psychiatry, University of California, San Francisco, CA, United States
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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15
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Nguyen AL, Lake JE, Preciado D, Liao D, Moore AA, Del Pino HE. A Modified Alcohol SBI for Use among Older Adults Living with HIV. West J Nurs Res 2020; 42:1155-1162. [PMID: 32238110 DOI: 10.1177/0193945920912946] [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: 11/15/2022]
Abstract
Older adults living with HIV may have health conditions that amplify the potentially negative health effects of alcohol use. We adapted the Comorbidity Alcohol Risk Evaluation Tool (CARET) screening tool for at-risk drinking to reflect HIV/AIDS and related conditions, medications, and behaviors. The adapted CARET-HIV along with a brief intervention was administered to 27 older men living with HIV. The CARET-HIV identified the same number of at-risk drinkers as the original CARET (n = 24) but identified more risk domains. Most participants welcomed receiving information about risks associated with their drinking, but some felt "embarrassed" or "guilty" discussing their drinking. This is particularly salient within the context of HIV discourse, which has historically assigned blame of HIV infection on personal choices. The SBI was generally acceptable to participants. The modified CARET can help providers integrate discussion of alcohol use into the context of HIV care for personalized feedback.
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Affiliation(s)
- Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Alhambra, CA, USA
| | - Jordan E Lake
- Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.,Division of Infectious Diseases, McGovern Medical School at the University of Texas, Houston, TX
| | - Diane Preciado
- Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Diana Liao
- Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Alison A Moore
- Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.,Division of Geriatrics, Departments of Medicine and Psychiatry, University of California, San Diego, La Jolla, CA
| | - Homero E Del Pino
- Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.,Department of Psychiatry and Human Behavior at Charles R. Drew University of Medicine and Science, Los Angeles, CA
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16
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Bertholet N, Cunningham JA, Adam A, McNeely J, Daeppen JB. Electronic screening and brief intervention for unhealthy alcohol use in primary care waiting rooms - A pilot project. Subst Abus 2019; 41:347-355. [PMID: 31364948 DOI: 10.1080/08897077.2019.1635963] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In primary care, electronic self-administered screening and brief interventions for unhealthy alcohol may overcome some of the implementation barriers of face-to-face intervention. We developed an anonymous electronic self-administered screening brief intervention device for unhealthy alcohol use and assessed its feasibility and acceptability in primary care practice waiting rooms. Two modes of delivery were compared: with or without the presence of a research assistant (RA) to make patients aware of the device's presence and help users. Using the device was optional. Methods: The devices were placed in 10 participating primary care practices waiting rooms for 6 weeks, and were accessible on a voluntary basis. Number of appointments by each practice during the course of the study was recorded. Access to the electronic brief intervention was voluntary among those who screened positive. Screening and brief intervention rates and characteristics of users were compared across the modes of delivery. Results: During the study, there were 7270 appointments and 1511 individuals used the device (20.8%). Mean age of users was 45.3 (19.5), and 57.9% screened positive for unhealthy alcohol use. Of them, 53.8% accessed the brief intervention content. The presence of the RA had a major impact on the device's usage (59.6% vs 17.4% when absent). When the RA was present, participants were less likely to screen positive (49.4% vs 60.7%, P = 0.0003) but more likely to access the intervention (62.7% vs 51.4%, P = 0.009). Results from the satisfaction survey indicated that users found the device easy to use (93.5%), questions useful (89-95%) and 77.2% reported that their friends would be willing to use it. Conclusions: This pilot project indicates that the implementation of an electronic screening and brief intervention device for unhealthy alcohol is feasible and acceptable in primary care practices but that, without human support, its use is rather limited.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Angéline Adam
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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17
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Bertholet N, Studer J, Cunningham JA, Gmel G, Burnand B, Daeppen JB. Four-year follow-up of an internet-based brief intervention for unhealthy alcohol use in young men. Addiction 2018; 113:1517-1521. [PMID: 29396897 DOI: 10.1111/add.14179] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/29/2017] [Accepted: 01/31/2018] [Indexed: 11/27/2022]
Abstract
AIM To estimate the long-term efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among men on (1) number of drinks/week and (2) monthly or more binge drinking prevalence. In addition, overall changes in alcohol use were assessed. DESIGN Participants in a cohort study were recruited in a two parallel-group randomized controlled trial of an IBI versus no-intervention control condition, showing a positive intervention effect at 6 months. As part of the regular cohort assessments, participants were re-assessed 47 months after the initial trial, offering an opportunity to determine long-term efficacy. SETTING Young Swiss men from the general population. PARTICIPANTS Of 737 randomized trial participants with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly, or Alcohol Use Disorders Identification Test (AUDIT) ≥ 8), 626 completed a cohort assessment at mean ± standard deviation (SD) = 47.4 ± 2.6) months after their randomized trial baseline assessment. INTERVENTION IBI included normative and personalized feedback on alcohol use, risk indicators, information about alcohol and health and recommendations; controls: assessment only. MEASUREMENTS Self-reported number of drinks/week and monthly or more binge drinking prevalence. FINDINGS Comparisons at follow-up were adjusted for baseline drinking. Missing values were replaced with the last observation carried forward. There was no evidence of differences between the IBI and control group on either the number of drinks/week [IBI: 10.8 (14.2); control: 10.7 (14.1), P = 0.8] or monthly or more binge drinking prevalence (IBI: 65.1%; control: 63.5%, P = 0.5). Although there was no evidence of overall change from baseline in number of drinks/week [9.8 (7.9) at baseline, 10.8 (14.1) at 47 months, P = 0.051], there was evidence that monthly or more binge drinking prevalence had decreased during the follow-up time (84.9% at baseline, 64.3% at 47 months, P < 0.001). CONCLUSIONS An internet-based brief intervention directed at unhealthy alcohol use among young men does not appear to reduce drinking over the long-term.
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Affiliation(s)
- Nicolas Bertholet
- Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Joseph Studer
- Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland
| | - John A Cunningham
- Center for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | - Gerhard Gmel
- Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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18
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Jonas DE, Garza D. An evidence-based approach to screening and providing appropriate interventions for unhealthy alcohol use in primary care settings. J Comp Eff Res 2016; 5:521-524. [PMID: 27582343 DOI: 10.2217/cer-2016-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Daniel E Jonas
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diego Garza
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Hahn JA, Emenyonu NI, Fatch R, Muyindike WR, Kekiibina A, Carrico AW, Woolf-King S, Shiboski S. Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction 2016; 111:272-9. [PMID: 26381193 PMCID: PMC4715487 DOI: 10.1111/add.13173] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 08/28/2014] [Revised: 07/20/2015] [Accepted: 09/16/2015] [Indexed: 12/13/2022]
Abstract
AIMS We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone. DESIGN A prospective 1-year observational cohort study with quarterly visits. SETTING Large rural HIV clinic in Mbarara, Uganda. PARTICIPANTS A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption. MEASUREMENTS Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use. FINDINGS The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively. CONCLUSIONS Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.
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Affiliation(s)
- Judith A. Hahn
- University of California, San Francisco, USA. Department of Medicine,University of California, San Francisco, USA. Department of Epidemiology and Biostatistics
| | - Nneka I. Emenyonu
- University of California, San Francisco, USA. Department of Medicine
| | - Robin Fatch
- University of California, San Francisco, USA. Department of Medicine
| | | | - Allen Kekiibina
- Mbarara University of Sciences and Technology, Uganda. Faculty of Medicine
| | - Adam W. Carrico
- University of California, San Francisco, USA. Department of Community Health Systems
| | - Sarah Woolf-King
- University of California, San Francisco, USA. Department of Medicine
| | - Stephen Shiboski
- University of California, San Francisco, USA. Department of Epidemiology and Biostatistics
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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, Rubinsky AD, Chavez LJ, Lapham GT, Rittmueller SE, Achtmeyer CE, Bradley KA. An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration. Addiction 2014; 109:1472-81. [PMID: 24773590 PMCID: PMC4257468 DOI: 10.1111/add.12600] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 05/03/2013] [Revised: 08/22/2013] [Accepted: 04/17/2014] [Indexed: 11/28/2022]
Abstract
AIMS The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation. DESIGN Observational, retrospective cohort study using secondary clinical and administrative data. SETTING Thirty VA facilities. PARTICIPANTS Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9-15 months later (n = 6210; 28%). MEASUREMENTS Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking). FINDINGS Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42-52%] and 48% (95% CI = 42-54%) for patients with and without documented brief intervention, respectively (P = 0.50). CONCLUSIONS During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.
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Affiliation(s)
- Emily C. Williams
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Department of Health Services, University of Washington, Seattle, WA, USA
| | - Anna D. Rubinsky
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Laura J. Chavez
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Department of Health Services, University of Washington, Seattle, WA, USA
| | - Gwen T. Lapham
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Group Health Research Institute, Seattle, WA, USA
| | - Stacey E. Rittmueller
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Carol E. Achtmeyer
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Primary and Specialty Medical Care Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Katharine A. Bradley
- Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA, Department of Health Services, University of Washington, Seattle, WA, USA, Group Health Research Institute, Seattle, WA, USA, Department of Medicine, University of Washington, Seattle, WA, USA
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Affiliation(s)
- Richard Saitz
- Departments of Community Health Sciences and Medicine, Boston University Schools of Public Health and Medicine, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, USA.
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Bertholet N, Cheng DM, Palfai TP, Saitz R. Factors associated with favorable drinking outcome 12 months after hospitalization in a prospective cohort study of inpatients with unhealthy alcohol use. J Gen Intern Med 2010; 25:1024-9. [PMID: 20480250 PMCID: PMC2955463 DOI: 10.1007/s11606-010-1382-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 09/25/2009] [Revised: 02/08/2010] [Accepted: 03/29/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Prevalence of unhealthy alcohol use among medical inpatients is high. OBJECTIVE To characterize the course and outcomes of unhealthy alcohol use, and factors associated with these outcomes. DESIGN Prospective cohort study. PARTICIPANTS A total of 287 medical inpatients with unhealthy alcohol use. MAIN MEASURES At baseline and 12 months later, consumption and alcohol-related consequences were assessed. The outcome of interest was a favorable drinking outcome at 12 months (abstinence or drinking "moderate" amounts without consequences). The independent variables evaluated included demographics, physical/sexual abuse, drug use, depressive symptoms, alcohol dependence, commitment to change (Taking Action), spending time with heavy-drinking friends and receipt of alcohol treatment (after hospitalization). Adjusted regression models were used to evaluate factors associated with a favorable outcome. KEY RESULTS Thirty-three percent had a favorable drinking outcome 1 year later. Not spending time with heavy-drinking friends [adjusted odds ratio (AOR) 2.14, 95% CI: 1.14-4.00] and receipt of alcohol treatment [AOR (95% CI): 2.16(1.20-3.87)] were associated with a favorable outcome. Compared to the first quartile (lowest level) of Taking Action, subjects in the second, third and highest quartiles had higher odds of a favorable outcome [AOR (95% CI): 3.65 (1.47, 9.02), 3.39 (1.38, 8.31) and 6.76 (2.74, 16.67)]. CONCLUSIONS Although most medical inpatients with unhealthy alcohol use continue drinking at-risk amounts and/or have alcohol-related consequences, one third are abstinent or drink "moderate" amounts without consequences 1 year later. Not spending time with heavy-drinking friends, receipt of alcohol treatment and commitment to change are associated with this favorable outcome. This can inform efforts to address unhealthy alcohol use among patients who often do not seek specialty treatment.
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Affiliation(s)
- Nicolas Bertholet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
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Bertholet N, Cheng DM, Palfai TP, Samet JH, Saitz R. Does readiness to change predict subsequent alcohol consumption in medical inpatients with unhealthy alcohol use? Addict Behav 2009; 34:636-40. [PMID: 19428189 PMCID: PMC2789443 DOI: 10.1016/j.addbeh.2009.03.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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] [Received: 08/12/2008] [Revised: 02/23/2009] [Accepted: 03/25/2009] [Indexed: 11/27/2022]
Abstract
We studied whether readiness to change predicts alcohol consumption (drinks per day) 3 months later in 267 medical inpatients with unhealthy alcohol use. We used 3 readiness to change measures: a 1 to 10 visual analog scale (VAS) and two factors of the Stages of Change Readiness and Treatment Eagerness Scale: Perception of Problems (PP) and Taking Action (TA). Subjects with the highest level of VAS-measured readiness consumed significantly fewer drinks 3 months later [Incidence rate ratio (IRR) and 95% confidence interval (CI): 0.57 (0.36, 0.91) highest vs. lowest tertile]. Greater PP was associated with more drinking [IRR (95%CI): 1.94 (1.02, 3.68) third vs. lowest quartile]. Greater TA scores were associated with less drinking [IRR (95%CI): 0.42 (0.23, 0.78) highest vs. lowest quartile]. Perception of Problems' association with more drinking may reflect severity rather than an aspect of readiness associated with ability to change; high levels of Taking Action appear to predict less drinking. Although assessing readiness to change may have clinical utility, assessing the patient's planned actions may have more predictive value for future improvement in alcohol consumption.
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Affiliation(s)
- Nicolas Bertholet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States.
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