A Randomized Controlled Trial of IVR-Based Alcohol Brief Intervention to Promote Patient–Provider Communication in Primary Care

Abstract

BACKGROUND: Brief interventions for unhealthy drinking in primary care settings are efficacious, but underutilized. Efforts to improve rates of brief intervention though provider education and office systems redesign have had limited impact. Our novel brief intervention uses interactive voice response (IVR) to provide information and advice directly to unhealthy drinkers before a physician office visit, with the goals of stimulating in-office dialogue about drinking and decreasing unhealthy drinking. This automated approach is potentially scalable for wide application. OBJECTIVE: We aimed to examine the effect of a pre-visit IVR-delivered brief alcohol intervention (IVR-BI) on patient-provider discussions of alcohol during the visit. DESIGN: This was a parallel group randomized controlled trial with two treatment arms: 1) IVR-BI or 2) usual care (no IVR-BI). PARTICIPANTS: In all, 1,567 patients were recruited from eight university medical center-affiliated internal medicine and family medicine clinics. INTERVENTIONS: IVR-BI is a brief alcohol intervention delivered by automated telephone. It has four components, based on the intervention steps outlined in the National Institute of Alcohol Abuse and Alcoholism guidelines for clinicians: 1) ask about alcohol use, 2) assess for alcohol use disorders, 3) advise patient to cut down or quit drinking, and 4) follow up at subsequent visits. MAIN MEASURES: Outcomes were patient reported: patient-provider discussion of alcohol during the visit; patient initiation of the discussion; and provider's recommendation about the patient's alcohol use. KEY RESULTS: Patients randomized to IVR-BI were more likely to have reported discussing alcohol with their provider (52 % vs. 44 %, p = 0.003), bringing up the topic themselves (20 % vs. 12 %, p < 0.001), and receiving a recommendation (20 % vs. 14 %, p < 0.001). Other predictors of outcome included baseline consumption, education, age, and alcohol use disorder diagnosis. CONCLUSIONS: Providing automated brief interventions to patients prior to a primary care visit promotes discussion about unhealthy drinking and increases specific professional advice regarding changing drinking behavior.

Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center

“…Specific to our clinic, while most nursing staff are bilingual English and Spanish or English and French speakers, they often care for patients who speak a different language. Although telephone interpreters are available on demand, this may create an unreasonable time delay; future work should examine alternatives such as interactive voice response or video-based BI for language-discordant encounters [ 34 , 35 ]. More generally, future evaluations of this model of routine SBI should evaluate fidelity of nursing staff to the recommended BI framework and, most importantly, effects on clinical outcomes such as self-reported drinking and disease control.…”

Perceptions on using interactive voice response surveys for non-communicable disease risk factors in Uganda: a qualitative exploration

“…High income countries have used interactive voice response (IVR) in screening for alcohol use and management of alcoholism (8,9). IVR is an automated system that interacts with the respondents, collects data and directs it to the recipient.…”

Thinking Outside the Visit: Digitally Extending the Reach of Behavioral Health

“…6 They use a Blow-tech^interactive voice response (IVR) system to conduct behavioral health screenings and, for risky alcohol use, brief interventions, including encouraging patients to discuss the issue with their provider. Rose and her colleagues at the University of Vermont have created a simple, straightforward screening approach for common behavioral health issues including pain, smoking, alcohol use, physical activity, weight concerns, and mood.…”

“…7 Rose and colleagues identified patients who screened positive for at-risk alcohol use, and randomly divided them into two groups, one who received an automated telephone brief intervention (IVR-BI) and a no-intervention control. 6 The BI followed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines, in which patients were asked about alcohol use, assessed for problems, advised (and assisted) to cut down, and encouraged to arrange follow-up care. Patients were then called after their primary care visit to Published online May 13, 2016 assess three simple factors: 1) did a conversation about alcohol occur, 2) who brought it up, and 3) did the provider make any recommendations about alcohol use to the patient.…”