Documented brief intervention not associated with resolution of unhealthy alcohol use one year later among VA patients living with HIV

Williams, Emily C.; Lapham, Gwen T.; Bobb, Jennifer F.; Rubinsky, Anna D.; Catz, Sheryl L.; Shortreed, Susan M.; Bensley, Kara M.; Bradley, Katharine A.

doi:10.1016/j.jsat.2017.04.006

Cited by 16 publications

(17 citation statements)

References 36 publications

(60 reference statements)

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“…Other studies evaluating measures of alcohol use severity before and after participating in SBIRT show similar results [ 41 ]. A more recent study among PLHIV, however, found that although alcohol use declined over time, the decline was not associated with receipt of a brief intervention [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another meta-analysis found little evidence that SBIRT increased patients’ receipt of care to reduce alcohol consumption [ 23 ]. A more recent study found no association between a brief intervention and resolution of alcohol use disorder at follow-up in PLHIV patients of the VA [ 24 ]. A qualitative study sought to identify facilitators and barriers to implementing SBIRT in primary care, and found general patient support for SBIRT, but also identified inconsistent implementation and provider lack of time as barriers [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting

Dawson–Rose¹,

Draughon

Cuca³

et al. 2017

Addict Sci Clin Pract

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BackgroundSubstance use is common among people living with HIV (PLHIV) and is associated with worse outcomes along the HIV care continuum. One potentially effective clinic-based approach to addressing unhealthy substance use is screening, brief intervention, and referral to treatment (SBIRT).MethodsWe conducted a two-arm randomized trial to examine the effects of a self-administered, computerized SBIRT intervention compared to a clinician-administered SBIRT intervention in an HIV primary clinic. Patients were surveyed before receiving the intervention and again at 1, 3, and 6 months. We administered the WHO Alcohol, Smoking and Substance Involvement Screening Test to determine Specific Substance Involvement Scores (SSIS) and to assign participants to categories of lower, moderate, or high risk to health and other problems for each substance. We collapsed moderate or severe risk responses into a single moderate–high risk category. Based on low rates of participation in the computerized arm, we conducted an “as treated” analysis to examine 6-month changes in mean SSIS among SBIRT intervention participants.ResultsFor the overall sample (n = 208), baseline mean SSIS were in the moderate risk category for alcohol, tobacco, cannabis, cocaine, amphetamine, sedatives and opioids. Of those enrolled, 134 (64.4%) received the intervention, and 109 (52.4%) completed the 6-month follow up. There was a statistically significant decline in mean SSIS for all substances except tobacco and cannabis among participants who were at moderate–high risk at baseline. We also observed a statistically significant increase in mean SSIS for all substances except amphetamines and sedatives among participants who were at lower risk at baseline.ConclusionsSubstance use among patients in this urban, safety-net, HIV primary care clinic was near universal, and moderate risk substance use was common. Among participants who received the SBIRT intervention, mean SSISs decreased among those at moderate–high risk at baseline, but increased among those at lower risk at baseline over the 6-month study period. Additional research should examine the clinical significance of SSIS changes for PLHIV, which SBIRT components drive changes in substance use scores, and what other interventions might support those patients at lower risk to maintain health and engagement along the HIV care continuum. Trial registration ClinicalTrials.gov study NCT01300806

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting

Dawson–Rose¹,

Draughon

Cuca³

et al. 2017

Addict Sci Clin Pract

View full text Add to dashboard Cite

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“…Alcohol SBI . The primary measure of alcohol SBI requires that a patient who has a PC visit has screened positive for unhealthy alcohol use on the day of the visit or in the past year (AUDIT-C ≥ 3 for women and ≥ 4 for men) and has a brief intervention documented on the day of the visit or in the following 14 days [ 48 ]. Our indicator of brief intervention is a composite measure based on two data sources: NLP and ICD codes.…”

Section: Methodsmentioning

confidence: 99%

“…Although implementation of alcohol SBI in the VA increased patient report of receiving alcohol-related advice [ 43 ], it also had limitations. The VA implementation strategies resulted in variable-quality screening [ 44 , 45 ], incomplete understanding and “ownership” of preventive alcohol-related care among front-line primary care (PC) staff [ 46 ], and unclear benefits in reducing consumption among patients [ 47 , 48 ]. Moreover, biased denominators may have impacted performance monitoring [ 45 , 49 ], and incentives to document brief intervention may have led to increased EHR documentation of brief intervention that was already occurring [ 50 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial)

et al. 2018

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BackgroundExperts recommend that alcohol-related care be integrated into primary care (PC) to improve prevention and treatment of unhealthy alcohol use. However, few healthcare systems offer such integrated care. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington (KPWA) partnered to design a high-quality program of evidence-based care for unhealthy alcohol use: the Sustained Patient-centered Alcohol-related Care (SPARC) program. SPARC implements systems of clinical care designed to increase both prevention and treatment of unhealthy alcohol use. This clinical care for unhealthy alcohol use was implemented using three strategies: electronic health record (EHR) decision support, performance monitoring and feedback, and front-line support from external practice coaches with expertise in alcohol-related care (“SPARC implementation intervention” hereafter).The purpose of this report is to describe the protocol of the SPARC trial, a pragmatic, cluster-randomized, stepped-wedge implementation trial to evaluate whether the SPARC implementation intervention increased alcohol screening and brief alcohol counseling (so-called brief interventions), and diagnosis and treatment of alcohol use disorders (AUDs) in 22 KPWA PC clinics.Methods/DesignThe SPARC trial sample includes all adult patients who had a visit to any of the 22 primary care sites in the trial during the study period (January 1, 2015–July 31, 2018). The 22 sites were randomized to implement the SPARC program on different dates (in seven waves, approximately every 4 months). Primary outcomes are the proportion of patients with PC visits who (1) screen positive for unhealthy alcohol use and have documented brief interventions and (2) have a newly recognized AUD and subsequently initiate and engage in alcohol-related care. Main analyses compare the rates of these primary outcomes in the pre- and post-implementation periods, following recommended approaches for analyzing stepped-wedge trials. Qualitative analyses assess barriers and facilitators to implementation and required adaptations of implementation strategies.DiscussionThe SPARC trial is the first study to our knowledge to use an experimental design to test whether practice coaches with expertise in alcohol-related care, along with EHR clinical decision support and performance monitoring and feedback to sites, increase both preventive care—alcohol screening and brief intervention—as well as diagnosis and treatment of AUDs.Trial registrationThe trial is registered at ClinicalTrials.Gov: NCT02675777. Registered February 5, 2016, https://clinicaltrials.gov/ct2/show/NCT02675777.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0795-9) contains supplementary material, which is available to authorized users.

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“…11 However, patients with HIV, who often report other substance use in addition to alcohol, 12 may require more extensive interventions. 13 To address this gap, the Health and Motivation Study compared usual care with two promising interventions to reduce unhealthy alcohol use and comorbid drug use, provided as a supplement to systematic SBIRT, within a large HIV primary care clinic.…”

Section: Introductionmentioning

confidence: 99%

Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial

et al. 2019

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BACKGROUND: Unhealthy alcohol use has adverse effects on HIV treatment. Screening, brief intervention, and referral to treatment (SBIRT) has some evidence of efficacy but may not be sufficient for those with low motivation or comorbid substance use. OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) and emailed feedback (EF) among primary care HIV-positive patients, compared with treatment as usual care (UC) only, which included SBIRT. DESIGN: Randomized clinical trial. PARTICIPANTS: Six hundred fourteen adult HIV-positive patients in Kaiser Permanente Northern California who reported prior-year unhealthy alcohol use. INTERVENTION: Participants were randomized to either three sessions of MI (one in person and two by phone), information regarding alcohol risks via EF through a patient portal, or UC alone. MI and EF participants who reported unhealthy alcohol use at 6 months were offered additional MI and EF treatment, respectively. MAIN MEASURES: Participant-reported unhealthy alcohol use (defined as ≥ 4/≥ 5 drinks per day for women/ men), alcohol problems at 12 months, based on blinded telephone interviews. Secondary outcomes included drug use and antiretroviral (ART) adherence. KEY RESULTS: At 12 months, there were no overall group differences, but in all three arms, there were declines in unhealthy alcohol use and alcohol-related problems (p < 0.001). Participants reporting low motivation to reduce drinking at baseline were less likely to report unhealthy alcohol use if they received MI vs. EF and UC (p = 0.013). At 6 months, reported illegal drug use/misuse of prescription drugs other than marijuana was lower in the MI arm than EF or UC (p = 0.012). There were no differences in ART adherence between groups. CONCLUSIONS: In a randomized trial of HIV-positive patients using two behavioral interventions compared with SBIRT alone, participants in all three conditions reduced unhealthy alcohol use. MI may provide added benefit for patients with low motivation or who report illegal drug use/misuse of prescription drugs.

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Documented brief intervention not associated with resolution of unhealthy alcohol use one year later among VA patients living with HIV

Cited by 16 publications

References 36 publications

Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting

Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting

Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial)

Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial

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