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Alcohol-related discussions during general medicine appointments of male VA patients who screen positive for at-risk drinking

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Abstract

OBJECTIVE: This study describes primary care discussions with patients who screened positive for at-risk drinking. In addition, discussions about alcohol use from 2 clinic firms, one with a provider-prompting intervention, are compared.

DESIGN: Cross-sectional analyses of audiotaped appointments collected over 6 months.

PARTICIPANTS AND SETTING: Male patients in a VA general medicine clinic were eligible if they screened positive for at-risk drinking and had a general medicine appointment with a consenting provider during the study period. Participating patients (N=47) and providers (N=17) were enrolled in 1 of 2 firms in the clinic (Intervention or Control) and were blinded to the study focus.

INTERVENTION: Intervention providers received patient-specific results of positive alcohol-screening tests at each visit.

MEASURES AND MAIN RESULTS: Of 68 visits taped, 39 (57.4%) included any mention of alcohol. Patient and provider utterances during discussions about alcohol use were coded using Motivational Interviewing Skills Codes. Providers contributed 58% of utterances during alcohol-related discussions with most coded as questions (24%), information giving (23%), or facilitation (34%). Advice, reflective listening, and supportive or affirming statements occurred infrequently (5%, 3%, and 5%, of provider utterances respectively). Providers offered alcohol-related advice during 21% of visits. Sixteen percent of patient utterances reflected “resistance” to change and 12% reflected readiness to change. On average, Intervention providers were more likely to discuss alcohol use than Control providers (82.4% vs 39.6% of visits; P=.026).

CONCLUSIONS: During discussions about alcohol, general medicine providers asked questions and offered information, but usually did not give explicit alcohol-related advice. Discussions about alcohol occurred more often when providers were prompted.

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Author information

Authors and Affiliations

  1. Received from Northwest Health Services Research and Development Center of Excellence, USA

    Katharine A. Bradley MD, MPH, Amee J. Epler BA, Jennifer L. Sporleder BS, Mary B. McDonell MS & Stephan D. Fihn MD, MPH

  2. the Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, USA

    Katharine A. Bradley MD, MPH & Stephan D. Fihn MD, MPH

  3. Center of Excellence in Substance Abuse Research and Education, VA Puget Sound Health Care System, USA

    Kristen R. Bush MPH

  4. the Department of Medicine, University of Washington, USA

    Katharine A. Bradley MD, MPH, Clarence H. Braddock III MD, MPH & Stephan D. Fihn MD, MPH

  5. the Department of Health Services, University of Washington, USA

    Katharine A. Bradley MD, MPH, Clarence H. Braddock III MD, MPH & Stephan D. Fihn MD, MPH

  6. Psychiatry and Behavioral Sciences, University of Washington, USA

    Christopher W. Dunn PhD

  7. Medical History and Ethics, University of Washington, USA

    Clarence H. Braddock III MD, MPH

  8. the Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Wash

    Christopher W. Dunn PhD

  9. the White River Junction VA Hospital, Dartmouth Medical School, White River Junction, Vt.

    Nancy E. Cochran MD

  10. the Department of Medicine and Community and Family Medicine, Dartmouth Medical School, White River Junction, Vt.

    Nancy E. Cochran MD

Authors
  1. Katharine A. Bradley MD, MPH
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  2. Amee J. Epler BA
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  3. Kristen R. Bush MPH
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  4. Jennifer L. Sporleder BS
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  5. Christopher W. Dunn PhD
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  6. Nancy E. Cochran MD
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  7. Clarence H. Braddock III MD, MPH
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  8. Mary B. McDonell MS
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  9. Stephan D. Fihn MD, MPH
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Corresponding author

Correspondence to Katharine A. Bradley MD, MPH.

Additional information

This research was supported by grants from the University of Washington Royalty Research Fund, and the Department of Veterans Affairs, Health Services Research and Development Service (SDR 96-002). Dr. Bradley is an investigator at the VA Puget Sound Health Care System, and is currently supported by National Institute of Alcohol Abuse and Alcoholism grant no. K23AA00313) and is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, the National Institute of Alcohol Abuse and Alcoholism, or the Robert Wood Johnson Foundation.

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Bradley, K.A., Epler, A.J., Bush, K.R. et al. Alcohol-related discussions during general medicine appointments of male VA patients who screen positive for at-risk drinking. J GEN INTERN MED 17, 315–326 (2002). https://doi.org/10.1007/s11606-002-0033-6

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  • DOI: https://doi.org/10.1007/s11606-002-0033-6

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