Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

Lu, Yun; Felicia, W.; Parthasarathy, Sujaya; Palzes, Vanessa A.; Kline-Simon, Andrea H.; Metz, Verena E.; Weisner, Constance; Satre, Derek D.; Campbell, Cynthia I.; Elson, Joseph; Ross, Thekla B.; Awsare, Sameer; Sterling, Stacy

doi:10.1111/acer.14702

Cited by 9 publications

(12 citation statements)

References 52 publications

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“…We found that female GPs and those with a longer duration of work experience were more positively impacted by the training intervention. This is consistent with the results of a study from the US that showed that female health care providers and those with longer tenure in the health system were more likely to adopt brief interventions for unhealthy alcohol use in an integrated health care system (30). Another study from the US examining the effectiveness of an SBIRT curriculum for emergency department (ED) staff showed that length of time in practice was positively associated with SBIRT utilization, controlling for gender, race, and type of profession (31).…”

Section: Discussionsupporting

confidence: 90%

Evaluation of a Training Program in General Practitioners’ Attitude Toward the Integration of Substance Use Disorders Services in Primary Health Care

Samandari

Khave

Janani

et al. 2022

Iran J Psychiatry Behav Sci

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Background: Substance use disorders (SUDs) are associated with high burdens for countries. It has been shown that the integration of SUD services into primary health care (PHC) can improve the early identification and treatment of people with SUDs. However, there are many barriers, including negative attitudes of health professionals about SUDs contributing to suboptimal care. Objectives: This study aimed to investigate the effectiveness of a training program on physicians’ attitudes toward providing SUD services in PHC. Methods: Physicians working in community health centers (CHCs) of Khorasan-e-Razavi Province in Iran were purposefully recruited to participate in a 10-hour in-person training program providing education on understanding the nature of SUDs, basic communication skills, motivational interviewing, and evidence-based SUDs interventions between October and December 2018. Knowledge and attitudes of participants were measured before and after training workshops. Results: The knowledge of physicians was significantly increased after completion of training. Moreover, participants’ attitudes toward the integration of SUD services into PHC significantly improved from 96.23 ± 0.90 to 109.22 ± 0.60 at the end of the workshop. In the multivariable linear regression, previous SUDs’ training experiences, being female, and years of work experience in PHC were significantly associated with more favorable attitudinal changes among the participants. Conclusions: Our results suggest the effectiveness of the training intervention in improving the attitudes toward SUD services among PHC physicians in Iran. Further controlled studies are needed to investigate the effectiveness of training on the attitudes of PHC professionals in the long term and its role in their practice.

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Section: Discussionsupporting

confidence: 90%

Evaluation of a Training Program in General Practitioners’ Attitude Toward the Integration of Substance Use Disorders Services in Primary Health Care

Samandari

Khave

Janani

et al. 2022

Iran J Psychiatry Behav Sci

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“…For example, the literature suggests that BP check-ups and hypertension awareness were higher among women than men but did not translate into better antihypertensive medication practice,61 and women with T2D exhibit worse control of HbA1c, BP and lipids than men 62–65. Research by our group66 67 and other researchers68 69 also found that women were less likely to receive BI when screened positive for unhealthy alcohol use, but a growing literature has described potential BI adaptations for women70 that might improve outcomes. Future studies, including non-randomised longitudinal studies with appropriate analytical approaches such as MSM-IPW, are also needed to estimate causal effects of BI over time while addressing time-varying confounders, including disease severity, provider attitudes and biases, psychological confounders and corresponding medication adherence.…”

Section: Discussionmentioning

confidence: 71%

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

et al. 2023

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ObjectivesTo evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).DesignA population-based observational study using electronic health records data.SettingAn integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care.ParticipantsAdult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017.Main outcome measuresWe examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and ‘controlled HbA1c’ (HbA1c<8%) at 18-month follow-up.ResultsFor patients with hypertension, those who received BI had a modest but significant additional −0.06 reduction in drinks/drinking day (95% CI −0.11 to −0.01) and additional −0.30 reduction in drinks/week (95% CI −0.59 to −0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined.ConclusionsAlcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI’s long-term public health impact.

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“…Excluding patients and providers with missing data, the final analytical sample was 287 551 patients and 2952 providers [52] (Figure 1). This study was approved by the KPNC Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

Disparities in the receipt of alcohol brief intervention: The intersectionality of sex, age, and race/ethnicity

et al. 2023

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Background and Aims: The increasing trend in alcohol consumption among women, exacerbated by the COVID-19 pandemic, is of growing concern. Screening, brief intervention, and referral to treatment in primary care is an efficacious and cost-effective treatment approach for unhealthy alcohol use. However, disparities exist in delivery of brief interventions by sex, age and race/ethnicity. This study measures brief intervention rates among eligible patients by sex, age and race/ethnicity and their intersectionality, in the context of a program of systematic alcohol screening and brief intervention program in adult primary care in a large, integrated health-care delivery system. Design, Setting and Participants: This was a population-based observational study among primary care clinics in an integrated health-care delivery system in Northern California, USA. The participants comprised adult (18+) patients (n = 287 551) screening positive for unhealthy alcohol use between January 2014 and December 2017. Measurements: Receipt of brief intervention, patient and provider characteristics from electronic health records.Findings: Multi-level logistic regression showed that women had lower odds of receiving brief intervention than men among all age, racial/ethnic groups and drinking levels. Sex differences were greater among those aged 35-49 years [odds ratio (OR) = 0.67, 95% confidence interval (CI) = 0.64, 0.69]) and 50-65 years (OR = 0.69, 95% CI =0.66, 0.72) than among other age groups. Sex differences in odds of receiving brief intervention were greater for the Latino/Hispanic group for women versus men (OR = 0.69, 95% CI = 0.66, 0.72) and smaller for the Asian/Pacific Islander group (OR = 0.76, 95% CI = 0.72, 0.81). Conclusion:In the United States, compared with men, women appear to have lower odds of receiving brief intervention for unhealthy alcohol use across all age groups, particularly during middle age. Black women and Latina/Hispanic women appear to be less likely to receive brief intervention than women in other race/ethnicity groups. Receipt of brief intervention does not appear to differ by drinking levels between men and women.

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Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

Cited by 9 publications

References 52 publications

Evaluation of a Training Program in General Practitioners’ Attitude Toward the Integration of Substance Use Disorders Services in Primary Health Care

Evaluation of a Training Program in General Practitioners’ Attitude Toward the Integration of Substance Use Disorders Services in Primary Health Care

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

Disparities in the receipt of alcohol brief intervention: The intersectionality of sex, age, and race/ethnicity

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