Brief alcohol counseling is a top US prevention priority but has not been widely implemented. The lack of an easy performance measure for brief alcohol counseling is one important barrier to implementation. The purpose of this report is to outline important issues related to measuring performance of brief alcohol counseling in health care settings. We review the strengths and limitations of several options for measuring performance of brief alcohol counseling and describe three measures of brief alcohol counseling tested in the Veterans Affairs (VA) Health Care System. We conclude that administrative data are not well-suited to measuring performance of brief alcohol counseling. Patient surveys appear to offer the optimal approach currently available for comparing performance of brief alcohol counseling across health care systems, while more options are available for measuring performance within health care systems. Further research is needed in this important area of quality improvement.

Background Alcohol use is associated with health behaviors that impact cardiovascular outcomes in patients with hypertension, including avoiding salt, exercising, weight management, and not smoking. This study examined associations between varying levels of alcohol use and self-reported cardiovascular health behaviors among hypertensive Veterans Affairs (VA) outpatients. Methods Male outpatients with self-reported hypertension from seven VA sites who returned mailed questionnaires (n=11,927) were divided into five levels of alcohol use: non-drinking, low-level use, and mild, moderate, and severe alcohol misuse based on AUDIT-C scores (0, 1-3, 4-5, 6-7 and 8-12, respectively). For each category, adjusted logistic regression models estimated the prevalence of patients who self-reported avoiding salt, exercising, controlling weight, or not smoking, and the composite of all four. Results Increasing level of alcohol use was associated with decreasing prevalence of avoiding salt, controlling weight, not smoking, and the combination of all four behaviors (p-values all <0.001). A linear trend was not observed for exercise (p=0.83), which was most common among patients with mild alcohol misuse (p=0.01 relative to non-drinking). Conclusions Alcohol consumption is inversely associated with adherence to cardiovascular self-care behaviors among hypertensive VA outpatients. Clinicians should be especially aware of alcohol use level among hypertensive patients.

Abstract:We conducted a standardized review of research on the prevalence of alcohol use or misuse (including alcohol use disorders), and the association of alcohol use or misuse with post-operative surgical complications among US patients. Twenty seven studies that included a preoperative measure of alcohol use or misuse and included at least 50 US surgical patients were identified using a standardized search strategy (1950( -April 2007. Twenty-two of the studies reported prevalence of alcohol use or misuse, which was highest in major otolaryngology surgeries (mostly for cancer and injuries: 22-88.5%) and thoracic surgery (lung transplant and cancer resections: 29-33%) and ranged from 8-28% in the remaining studies. Nineteen studies examined the association between pre-operative alcohol consumption and post-operative complications suggesting positive associations between alcohol use or misuse and risk for post-operative delirium, pneumonia, cognitive decline, overall complications, and death. Most identified studies had methodological limitations, especially the widespread use of drinking assessment methods that cannot distinguish alcohol use from misuse.