Rates and predictors of brief intervention for women veterans returning from recent wars: Examining gaps in service delivery for unhealthy alcohol use

Pugatch, Marianne; Chang, Grace; Garnick, Deborah W.; Brolin, Mary; Brief, Deborah J.; Miller, Christopher J.; Fleming, Jerry; D, Blaney; Harward, Brian M.; Hodgkin, Dominic

doi:10.1016/j.jsat.2020.108257

Cited by 2 publications

(3 citation statements)

References 42 publications

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“…While no overall significant interaction was found, our finding that women who exceeded both daily and weekly limits had greater odds of receiving a BI than those exceeding only weekly or daily limits is reassuring, suggesting that more severe problems are being addressed and in line with earlier research [86], but concerning in the sense that lower severity problems may not be identified and intervened upon as early as possible. Although men and women have similar rates of exceeding both daily and weekly limits (~13%), women had lower odds of receiving BI.…”

Section: Discussionsupporting

confidence: 74%

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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Section: Discussionsupporting

confidence: 74%

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

et al. 2023

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“…Because the electronic clinical reminder was triggered for an AUDIT-C score ≥5 regardless of gender, we could not repeat our analyses among women using a lower AUDIT-C threshold preventing equivalent comparison of veterans with unhealthy alcohol use by gender. Future research should examine if these results extend to veterans with less severe unhealthy alcohol use (e.g., AUDIT-C score ≥4 for men and ≥3 for women) 27 . Research suggests that the implementation of the electronic clinical practice reminder with a higher gender-nonspecific AUDIT-C threshold resulted in increased receipt of brief intervention for both men and women but also increased the gender disparity brief intervention rates 28 .…”

Section: Discussionmentioning

confidence: 98%

“…Future research should examine if these results extend to veterans with less severe unhealthy alcohol use (e.g., AUDIT-C score ≥4 for men and ≥3 for women). 27 Research suggests that the implementation of the electronic clinical practice reminder with a higher gender-nonspecific AUDIT-C threshold resulted in increased receipt of brief intervention for both men and women but also increased the gender disparity brief intervention rates. 28 Finally, our study of veterans receiving care within the VA may not generalize to patients with concurrent unhealthy alcohol use and LTOT in other clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Alcohol-Related Care Among Veterans With Unhealthy Alcohol Use: The Role of Long-term Opioid Therapy Receipt

Joudrey,

Wang,

DeRycke

et al. 2024

J Addict Med

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Objectives Long-term opioid therapy (LTOT) is potentially dangerous among patients with unhealthy alcohol use because of possible adverse interactions. We examined receipt of alcohol-related care among patients with unhealthy alcohol use receiving LTOT and without opioid receipt. Methods We use data collected from 2009 to 2017 in the Women Veterans Cohort Study, a national cohort of Veterans engaged in Veterans Health Administration care. We included patients who screened positive for unhealthy alcohol use (score ≥5) using the Alcohol Use Disorder Identification Consumption questionnaire. Our primary exposure was LTOT (receipt of prescribed opioids for ≥90 days) versus no opioid receipt at the time of the first positive Alcohol Use Disorder Identification Consumption. Our primary outcome was receipt of brief intervention within 14 days of positive alcohol screen. Unadjusted and 4 adjusted modified Poisson regression models assessed prevalence and relative rates (RRs) of outcomes. Results Among eligible veterans, 6222 of 113,628 (5.5%) received LTOT at screening. Among patients receiving LTOT, 67.5% (95% confidence interval [CI], 66.3%–68.6%) had a documented brief intervention within 14 days of positive screen, compared with 70.1% (95% CI, 69.8%–70.4%) among patients without opioid receipt (RR, 0.96; 95% CI, 0.95–0.98; P < 0.001). Within adjusted models, the rate of brief intervention among patients receiving LTOT remained lower than patients without opioid receipt. Conclusions Among patients with unhealthy alcohol use, patients receiving LTOT had significantly lower rates of brief intervention receipt compared with those without opioid receipt, and they should be a focus for interventions to improve alcohol-related care and safer opioid prescribing.

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Rates and predictors of brief intervention for women veterans returning from recent wars: Examining gaps in service delivery for unhealthy alcohol use

Cited by 2 publications

References 42 publications

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

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

Alcohol-Related Care Among Veterans With Unhealthy Alcohol Use: The Role of Long-term Opioid Therapy Receipt

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