Utility of Prompting Physicians for Brief Alcohol Consumption Intervention

Abstract

A comprehensive prompting strategy designed to maximize the rate of Brief Intervention (BI) for “heavy drinking” was implemented from 2001 to 2003 for a randomized controlled trial of a post-BI treatment enhancement. Thirty-one internists at four outpatient practices in a county of 150,000 in a rural US state documented their BI's using an intervention checklist. The prompting procedures implemented in this study yielded documented BI for 39% of identified cases, but participation rates varied by physician and clinic and over time. The overall rate was lower than expected. Implications and recommendations for future BI research and training are offered; the paper's limitations are discussed.

RÉSUMÉ

Une stratégie d’incitation détaillée, conçue pour améliorer le taux d’interventions brèves (IB) auprès des consommateurs excessifs d’alcool, a été mise en place de 2001 à 2003 dans le cadre d’un essai contrôlé randomisé visant à améliorer le traitement à la suite d’une intervention brève. Trente et un internistes dans quatre centres de consultations externes d’un comté de 150 000 habitants, situé dans un État rural, ont étayé leurs interventions brèves en ayant recours à une liste de vérification de l’intervention. Les procédures d’incitation mises en place dans cette étude ont permis de documenter les IB dans 39% des cas identifiés, mais les taux de participation ont varié selon le médecin, la clinique, et au fil du temps. Le taux global était inférieur à celui attendu. Les conséquences sur de futures recherches en matière d’IB ainsi que des recommandations sont formulées; les limitations font l’objet d’un examen.

RESUMEN

Una estrategia puntual extensa diseñada para maximizar el índice de Intervención Breve (BI por sus siglas en inglés) de ingestión alcohólica se implentó entre 2001 y 2003 para una prueba aleatoria controlada posterior al aumento en el tratamiento de Intervención Breve. Treinta y un internistas en cuatro clínicas de consulta externa en un condado de 150,000 habitantes dentro de un estado rural documentaron su IB usando una lista de intervención. Los rápidos procedimientos implementados en este estudio produjeron un IB documentado en el 39% de los casos identificados, pero los indices de participación varían por médico, clínica, y tiempo. El índice total fue menor del esperado. Implicaciones y recomendaciones para una futura investigación y entrenamiento en IB son ofrecidas; las limitaciones son discutidas.

Keywords :

• primary health care
• alcohol drinking
• physician's practice patterns
• preventive health services
• heath services research
• alcohol use screening method
• physician prompting
• at-risk drinking
• hazardous drinkers
• problem drinking

THE AUTHORS

Gail L. Rose, Ph.D., is a Research Assistant Professor in the Psychiatry Department at the University of Vermont College of Medicine, Burlington, Vermont, U.S.A., and Assistant Professor in the UVM College of Education and Social Services, Burlington, Vermont, U.S.A. For the past 10 years she has been conducting clinical research on alcohol use and misuse as Project Director at the Health Behavior Research Center. She has been involved in continuing medical education/training for identification and treatment of alcohol use disorders using a motivational interviewing approach and in the training of clinical psychology doctoral students in cognitive behavioral therapy for alcohol abuse and dependence. Dr. Rose is also involved in mentoring, doctoral student development, and clinical and research training for doctoral students across disciplines.

Dennis A. Plante, M.D., has been a practicing General Internist at the University of Vermont, College of Medicine, since 1984. He has a special interest in both Medical Decision Making and in the applications of Quality Improvement ideas to clinical medicine. As a faculty member in the College of Medicine, Dr. Plante is involved in teaching both medical students and residents in training in the Department of Medicine Health Care Service. He has been involved in collaborative research with investigators from the University of Vermont and the State of Vermont. He is currently a regional collaborator in the State of Vermont's Governor's Blueprint for Health – a new initiative to improve the quality of health care by applying the principles of the Chronic Care Model of Wagner.

Colleen S. Thomas, M.S., is a statistical analyst at the University of Vermont, where she also received her M.S. in Biostatistics in 2003. She has consulted to the Health Behavior Research Center on a number of projects during the past three years. In addition, she has co-authored several journal articles relating to substance use. Her interests include SAS programming, data cleaning techniques, hierarchical linear models, and repeated measures designs.

Laura J. Denton, B.A., has her bachelor's degree in Psychology and English Literature. She is currently the Study Conduct Support Coordinator at Duke University's Clinical Research Support Office, where she assists with regulatory training and communications for Duke University's School of Medicine in Durham, North Carolina. Ms. Denton was a Research Assistant on the project referred to in this article while working at the Health Behavior Research Center at the University of Vermont. She also worked on developing protocols for the North Central Cancer Treatment Group (NCCTG), whose research base is housed in the Cancer Center at the Mayo Clinic in Rochester Minnesota.

John E. Helzer, M.D., is a Professor of Psychiatry at the University of Vermont College of Medicine and the Director of the Health Behavior Research Center at the University. He and Dr. Rose have been research collaborators for the past 10 years. Their research is focused on developing simple technologies to create behavioral tools that patients can use to guide and enhance their own self-care. Dr. Helzer's research background is in Psychiatric Epidemiology, intervention, and Psychiatric Taxonomy. Currently, he devotes most of his time to research but is also engaged in patient care and teaching at the College of Medicine.

Notes

1 Symptoms included recurrent abdominal pains, intermittently elevated blood pressure and gastritis visible on gastroscopy, irritability and waking up frequently at night. The vignette noted that the patient was married, had job-related anxiety and stress, but reported normal libido and no previous psychiatric history.

2 As stated in their fact sheet (http://www.ahrq.gov/clinic/uspstfab.htm), “The U.S. Preventive Services Task Force (USPSTF) first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the ‘gold standard’ for clinical preventive services.

 The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.”

3 The General Health Questionnaire is available by request from the author.

4 Three RAs worked on this project. All were female. They had bachelor's degrees in psychology or nursing, and prior experience doing psychological research and/or clinical care.