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Use of an Electronic Clinical Reminder for Brief Alcohol Counseling is Associated with Resolution of Unhealthy Alcohol Use at Follow-Up Screening

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Abstract

BACKGROUND/OBJECTIVE

Brief alcohol counseling is a foremost US prevention priority, but no health-care system has implemented it into routine care. This study evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling (“reminder”). The specific aims were to (1) determine the prevalence of use of the reminder and (2) evaluate whether use of the reminder was associated with resolution of unhealthy alcohol use at follow-up screening.

METHODS

The reminder was implemented in February 2004 in eight VA clinics where providers routinely used clinical reminders. Patients eligible for this retrospective cohort study screened positive on the AUDIT-C alcohol screening questionnaire (February 2004–April 2006) and had a repeat AUDIT-C during the 1–36 months of follow-up (mean 14.5). Use of the alcohol counseling clinical reminder was measured from secondary electronic data. Resolution of unhealthy alcohol use was defined as screening negative at follow-up with a ≥2-point reduction in AUDIT-C scores. Logistic regression was used to identify adjusted proportions of patients who resolved unhealthy alcohol use among those with and without reminder use.

RESULTS

Among 4,198 participants who screened positive for unhealthy alcohol use, 71% had use of the alcohol counseling clinical reminder documented in their medical records. Adjusted proportions of patients who resolved unhealthy alcohol use were 31% (95% CI 30–33%) and 28% (95% CI 25–30%), respectively, for patients with and without reminder use (p-value = 0.031).

CONCLUSIONS

The brief alcohol counseling clinical reminder was used for a majority of patients with unhealthy alcohol use and associated with a moderate decrease in drinking at follow-up.

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References

  1. Room R, Babor T, Rehm J. Alcohol and public health. Lancet. 2005;365:519–30.

    PubMed  Google Scholar 

  2. U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–56.

    Google Scholar 

  3. Kaner E, Beyer F, Dickinson H, Pienaar E, Campbell F, Schlesinger C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007:CD004148.

  4. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002;26:36–43.

    PubMed  Google Scholar 

  5. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34:143–52.

    Article  PubMed  Google Scholar 

  6. Bradley KA, Epler AJ, Bush KR, Sporleder JL, Dunn CW, Cochran NE, et al. Alcohol-related discussions during general medicine appointments of male VA patients who screen positive for at-risk drinking. J Gen Intern Med. 2002;17:315–26.

    PubMed  Google Scholar 

  7. Conigliaro J, Lofgren RP, Hanusa BH. Screening for problem drinking: impact on physician behavior and patient drinking habits. J Gen Intern Med. 1998;13:251–56.

    Article  CAS  PubMed  Google Scholar 

  8. Richmond R, Kehoe L, Heather N, Wodak A, Webster I. General practitioners’ promotion of healthy life styles: what patients think. Aust NZ J Public Health. 1996;20:195–200.

    Article  CAS  Google Scholar 

  9. Volk RJ, Steinbauer JR, Cantor SB. Patient factors influencing variation in the use of preventive interventions for alcohol abuse by primary care physicians. J Stud Alcohol. 1996;57:203–9.

    CAS  PubMed  Google Scholar 

  10. Kaner EFS, Heather N, Brodie J, Lock CA, McAvoy BR. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract. 2001;51:822–7.

    CAS  PubMed  Google Scholar 

  11. Burman ML, Kivlahan DR, Buchbinder MB, Broglio K, Zhou XH, Merrill JO, et al. Alcohol-related advice for VA primary care patients: who gets it, who gives it? J Stud Alc. 2004;65:621–30.

    Google Scholar 

  12. Arndt S, Schultz SK, Turvey C, Petersen A. Screening for alcoholism in the primary care setting: are we talking to the right people? J Fam Pract. 2002;51:41–6.

    PubMed  Google Scholar 

  13. Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12:597–606.

    PubMed  Google Scholar 

  14. Saitz R, Horton NJ, Sullivan LM, Moskowitz MA, Samet JH. Addressing alcohol problems in primary care: a cluster randomized, controlled trial of a systems intervention. The screening and intervention in primary care (SIP) study. Ann Intern Med. 2003;138:372–82.

    PubMed  Google Scholar 

  15. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Jama. 2005;293:1223–38.

    Article  CAS  PubMed  Google Scholar 

  16. Hung DY, Rundall TG, Tallia AF, Cohen DJ, Halpin HA, Crabtree BF. Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q. 2007;85:69–91.

    Article  PubMed  Google Scholar 

  17. Kerr EA, Fleming B. Making performance indicators work: experiences of US Veterans Health Administration. BMJ. 2007;335:971–73.

    Article  PubMed  Google Scholar 

  18. Oliver A. Public-sector health-care reforms that work? A case study of the US Veterans Health Administration. Lancet. 2008;371:1211–13.

    Article  PubMed  Google Scholar 

  19. Kizer KW, Dudley RA. Extreme makeover: transformation of the veterans health care system. Annu Rev Public Health. 2009;30:313–39.

    Article  PubMed  Google Scholar 

  20. Fung CH, Woods JN, Asch SM, Glassman P, Doebbeling BN. Variation in implementation and use of computerized clinical reminders in an integrated healthcare system. Am J Manag Care. 2004;10:878–85.

    PubMed  Google Scholar 

  21. Saleem JJ, Patterson ES, Militello L, Render ML, Orshansky G, Asch SM. Exploring barriers and facilitators to the use of computerized clinical reminders. J Am Med Inform Assoc. 2005;12:438–47.

    Article  PubMed  Google Scholar 

  22. Bradley KA, Williams EC, Achtmeyer CE, Hawkins EJ, Harris AH, Frey MS, et al. Measuring performance of brief alcohol counseling in medical settings:a review of the options and lessons from the Veterans Affairs (VA) health care system. Subst Abus. 2007;28:133–49.

    Article  PubMed  Google Scholar 

  23. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158:1789–95.

    Article  CAS  PubMed  Google Scholar 

  24. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med. 2003;163:821–9.

    Article  PubMed  Google Scholar 

  25. Matzger H, Delucchi K, Weisner C, Ammon L. Does marital status predict long-term drinking? Five-year observations of dependent and problem drinkers. J Stud Alcohol. 2004;65:255–65.

    PubMed  Google Scholar 

  26. Weisner C, Matzger H, Kaskutas LA. How important is treatment? One-year outcomes of treated and untreated alcohol-dependent individuals. Addiction. 2003;98:901–11.

    Article  PubMed  Google Scholar 

  27. Bradley KA, Kivlahan DR, Zhou XH, Sporleder JL, Epler AJ, McCormick KA, et al. Using alcohol screening results and treatment history to assess the severity of at-risk drinking in Veterans Affairs primary care patients. Alcohol Clin Exp Res. 2004;28:448–55.

    Article  PubMed  Google Scholar 

  28. Au DH, Kivlahan DR, Bryson CL, Blough D, Bradley KA. Alcohol screening scores and risk of hospitalizations for GI conditions in men. Alcohol Clin Exp Res. 2007;31:443–51.

    Article  PubMed  Google Scholar 

  29. Harris AH, Bryson CL, Sun H, Blough D, Bradley KA. Alcohol screening scores predict risk of subsequent fractures. Subst Use Misuse. 2009;44:1055–69.

    Article  PubMed  Google Scholar 

  30. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.

    Article  CAS  PubMed  Google Scholar 

  31. StataCorp. Stata Statistical Software: Release Special Edition 10.1. College Station TX: Stata Corporation 2007.

  32. Beach MC, Gary TL, Price EG, Robinson K, Gozu A, Palacio A, et al. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions. BMC Public Health. 2006;6:104.

    Article  PubMed  Google Scholar 

  33. Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994;120:135–42.

    CAS  PubMed  Google Scholar 

  34. Dexheimer JW, Talbot TR, Sanders DL, Rosenbloom ST, Aronsky D. Prompting clinicians about preventive care measures: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2008;15:311–20.

    Article  PubMed  Google Scholar 

  35. Nilsen P, Aalto M, Bendtsen P, Seppa K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review. Scand J Prim Health Care. 2006;24:5–15.

    Article  PubMed  Google Scholar 

  36. Kuehn BM. Despite benefit, physicians slow to offer brief advice on harmful alcohol use. JAMA. 2008;299:751–3.

    Article  CAS  PubMed  Google Scholar 

  37. Kaner EF, Wutzke S, Saunders JB, Powell A, Morawski J, Bouix JC. Impact of alcohol education and training on general practitioners’ diagnostic and management skills: findings from a World Health Organization collaborative study. J Stud Alcohol. 2001;62:621–7.

    CAS  PubMed  Google Scholar 

  38. Babor TF, Higgins-Biddle JC. Cutting back (R): Managed care screening and brief intervention for risky drinking. The Robert Wood Johnson Foundation. 2004. Available at: http://www.rwjf.org/reports/npreports/cuttingback.htm. Accessed August 10, 2009.

  39. Rose HL, Miller PM, Nemeth LS, Jenkins RG, Nietert PJ, Wessell AM, et al. Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention. Addiction. 2008;103:1271–80.

    Article  PubMed  Google Scholar 

  40. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, et al. Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004;39:351–6.

    PubMed  Google Scholar 

  41. Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996;156:2287–93.

    Article  CAS  PubMed  Google Scholar 

  42. Beich A, Gannik D, Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ. 2002;325:1–5.

    Article  Google Scholar 

  43. McCormick KA, Cochran NE, Back AL, Merrill JO, Williams EC, Bradley KA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–72.

    Article  PubMed  Google Scholar 

  44. Ockene J, Adams A, Hurley T, Wheeler E, Hebert J. Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: does it work? Arch Intern Med. 1999;159:2198–205.

    Article  CAS  PubMed  Google Scholar 

  45. Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med. 1997;12:274–83.

    Article  CAS  PubMed  Google Scholar 

  46. Miller WR. Rediscovering fire: small interventions, large effects. Psychol Addict Behav. 2000;14:6–18.

    Article  CAS  PubMed  Google Scholar 

  47. Hamlett-Berry K, Davison J, Kivlahan DR, Matthews MH, Hendrickson JE, Almenoff PL. Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration. Mil Med. 2009;174:29–34.

    PubMed  Google Scholar 

  48. Patterson ES, Nguyen AD, Halloran JP, Asch SM. Human factors barriers to the effective use of ten HIV clinical reminders. J Am Med Inform Assoc. 2004;11:50–9.

    Article  PubMed  Google Scholar 

  49. Schellhase KG, Koepsell TD, Norris TE. Providers’ reactions to an automated health maintenance reminder system incorporated into the patient’s electronic medical record. J Am Board Fam Pract. 2003;16:312–7.

    Article  PubMed  Google Scholar 

  50. Mayo-Smith MF, Agrawal A. Factors associated with improved completion of computerized clinical reminders across a large healthcare system. Int J Med Inform. 2007;76:710–6.

    Article  PubMed  Google Scholar 

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Acknowledgements

The clinical reminder evaluated in this study was developed with funding from The Robert Wood Johnson Foundation’s Generalist Physicians Faculty Scholars Program. This study was supported by the Veteran’s Affairs (VA) Substance Use Disorders Quality Enhancement Research Initiative (SUD QuERI) and the VA’s Northwest Center of Excellence for Health Services Research and Development. The authors gratefully acknowledge Haili Sun, PhD, for data extraction and management and Thomas M. Wickizer, PhD, Thomas D. Koepsell, MD, MPH, and Patrick J. Heagerty, PhD, for careful review of and helpful comments on the analytical plan.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Northwest Center of Excellence for Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA

    Emily C. Williams PhD, MPH, Gwen Lapham MPH, MSW, Carol E. Achtmeyer MN, Daniel R. Kivlahan PhD & Katharine A. Bradley MD, MPH

  2. Primary and Specialty Medical Care Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA

    Carol E. Achtmeyer MN & Katharine A. Bradley MD, MPH

  3. Departments of Medicine, University of Washington, Seattle, WA, USA

    Katharine A. Bradley MD, MPH

  4. Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Daniel R. Kivlahan PhD

  5. Health Services, University of Washington, Seattle, WA, USA

    Emily C. Williams PhD, MPH & Gwen Lapham MPH, MSW

  6. VA Northern California Healthcare System, Martinez, CA, USA

    Bryan Volpp MD

Authors
  1. Emily C. Williams PhD, MPH
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  2. Gwen Lapham MPH, MSW
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  3. Carol E. Achtmeyer MN
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  4. Bryan Volpp MD
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  5. Daniel R. Kivlahan PhD
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  6. Katharine A. Bradley MD, MPH
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Corresponding author

Correspondence to Emily C. Williams PhD, MPH.

Additional information

The clinical reminder evaluated in this study was developed with funding from The Robert Wood Johnson Foundation’s Generalist Physicians Faculty Scholars Program. This study was supported by the Veteran’s Affairs (VA) Substance Use Disorders Quality Enhancement Research Initiative (SUD QuERI) and the VA’s Northwest Center of Excellence for Health Services Research and Development. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Washington. Preliminary versions of this work were presented at the 2008 Addiction Health Services Research annual meeting and included in the dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy from the University of Washington (completed by ECW June 2009).

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Williams, E.C., Lapham, G., Achtmeyer, C.E. et al. Use of an Electronic Clinical Reminder for Brief Alcohol Counseling is Associated with Resolution of Unhealthy Alcohol Use at Follow-Up Screening. J GEN INTERN MED 25 (Suppl 1), 11–17 (2010). https://doi.org/10.1007/s11606-009-1100-z

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  • DOI: https://doi.org/10.1007/s11606-009-1100-z

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