Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Abstract

BackgroundMost patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample.Methods The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011–2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.ResultsA total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22–75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14–24] and a median readiness to change drinking score of 5 (IQR 2.75–6.25) on a 1–10 Likert scale.ConclusionThe CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).Electronic supplementary materialThe online version of this article (doi:10.1186/s13722-017-0080-2) contains supplementary material, which is available to authorized users.

Treatment for Alcohol Dependence in Primary Care Compared to Outpatient Specialist Treatment—A Randomized Controlled Trial

“…This is a patient-centred model, which often includes; identification, attempts to engage the patient in care, monitoring and treatments according to the patient's needs. A multidisciplinary team consisting of psychiatrist, psychologist, social worker and nurse can deliver the care, and it is then often referred to as "collaborative care" (92,93). As suggested by the name, the team collaborates with the primary care staff around the care of the patient.…”

“…Willenbring adapted the CCM to management of alcohol dependence, where it mainly has been applied to management of severe alcohol dependence, in populations where medical, psychiatric and social issues are common (92,(94)(95)(96)(97)(98). The intervention often lasts 12 months.…”

“…The findings in study III and IV indicate that treatment for alcohol dependence can be simplified, for this group of patients with low to moderate severity of dependence and few psychiatric co-morbidities. The 15method includes fewer and briefer sessions compared to existing models of treatment in primary care (92,94,95,97,98). In addition, the general practitioners only received a brief one-day training, which means the model can be readily implemented.…”

Intervenção breve aplicada a universitários consumidores de risco de bebidas alcoólicas

“…Estudo longitudinal que utilizou a RPM com suíços, abusadores e dependentes de álcool encontrou pontuação mais alta na prontidão e confiança para decisão de parar de beber e manter abstinência e menor pontuação para a importância de mudar o comportamento de beber (23) . Norte-americanos entre 21 e 75 anos, classificados como consumidores abusivos ou dependentes de álcool, acompanhados em serviços de atenção primária, receberam IB por enfermeiras e na sequência demonstraram prontidão para mudança e 36% informaram ser importante mudar o comportamento do consumo de álcool; 44,1% estavam muito confiantes na capacidade de mudar; e 42,8% mais ou menos prontos para mudar (24) . Neste estudo, 52,2% dos universitários de enfermagem, que após a 2ª IB estavam no padrão do baixo risco do consumo de álcool, relataram, por meio da RPM, que estavam prontos para mudar o padrão de consumo de álcool e 75% dos que estavam no padrão de uso de risco referiram estar apenas pensando em mudar.…”

An effectiveness-implementation hybrid trial study protocol targeting posttraumatic stress disorder and comorbidity

“…The Alcohol Use Disorder Identification Test (AUDIT), a ten-item screening instrument for the early identification of problem drinkers will be used to assess alcohol use problems before and after the injury hospitalization [ 85 ]. The AUDIT’s reliability and validity are well established, and the scale has been widely used in acute and primary care medical settings [ 16 , 25 , 85 – 87 ]. Limitations in physical function .…”