Brief interventions for high-risk drinkers in the primary care setting: A pilot study
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Aim. The aims of this pilot study were to (a) describe the extent to which primary care providers (PCP) at the Veterans Administration (VA) fully implement clinical practice guidelines (CPG) for VA primary care patients who fail their Audit C, (b) conduct a supplemental intervention to complete all elements of the CPG, and (c) estimate the extent to which the patient's drinking is reduced thereby. Background. It has been found that brief interventions (BI) can decrease alcohol consumption among high-risk primary care patients and that PCPs do not fully implement clinical practice guidelines (CPG) that call for BIs. Two theoretical frameworks guided this study, the Quality Health Outcomes Model and the Transtheoretical Model of Change. Methods. Patients who had been identified as drinking to excess were randomly assigned to receive usual care alone (UC) or UC plus a supplemental BI. Patient Exit Questionnaires and chart reviews were used to evaluate the extent to which elements of the CPG were provided. Drinking levels were measured at baseline and at two months, using the Timeline Followback. Findings. Forty-five patients participated, but follow-up data could be collected only for 31 patients. PCPs recorded alcohol-related discussion/intervention on the patient's chart 77% of the time. Patients reported that at least one component of the CPG was implemented by the PCP 70% of the time, but that only 37% of the VA practice guideline was implemented. The estimated treatment effect of the supplementary intervention was 4.02 drinks/wk, which is consistent with the literature, but this was not statistically significant. The treatment effect was significantly greater for patients who drank more at baseline. Conclusion. The VA CPG for risky drinking was not completely implemented in usual care. Pilot data suggested that a more complete intervention would benefit at least the heaviest drinkers, but replication with a larger sample size will be required. Key Words. Primary care, clinical practice guideline, high-risk drinking, alcohol, brief intervention, outcomes model, translation research.