An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration

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.

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

“…The AUDIT-C electronic clinical reminder is "due" annually and "triggered" 9 months after the previous screen. 25 No preferred approach to screening (e.g., paper questionnaire or in-person verbal interview) has been specified by national VA policy, but it is common for care incentivized by performance measures to be documented using electronic clinical reminders. 25 …”

A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health‐care settings

“…Examples of studies documenting the implementation of SBI in medical settings in the United States include studies in emergency departments (EDs) [4,5], in-patient units [6] and primary care [7]. SBI for alcohol use in primary care has a strong evidence base [8,9].…”

A systematic review of the effectiveness of alcohol brief interventions for the UK military personnel moving back to civilian life

“…Study designs included randomised controlled trials (RCTs),26 27 controlled clinical trials (CCTs)28–31 and retrospective secondary data analyses 24 25 32. Eligibility for all studies was screening positive for unhealthy alcohol use or drinking above recommended guidelines apart from two studies.…”

“…Heterogeneity of study design and shared recruitment sources24 25 meant meta-analysis was inappropriate and results were synthesised narratively.…”