Alcohol-related discussions in primary care: a report from ASPN. Ambulatory Sentinel Practice Network.
BACKGROUND
Problem drinking is common, and a 15-minute intervention can help some patients reduce drinking to safe levels. Little is known, however, about the frequency and duration of alcohol-related discussions in primary care.


METHODS
Nineteen clinicians in the Ambulatory Sentinel Practice Network (ASPN) collected data about alcohol-related discussions for 1 week following their usual office routine (Phase 1) and for 1 week with the addition of routine screening for problem drinking (Phase 2). Of those, 15 clinicians collected data for a third week after receiving training in brief interventions with problem drinkers (Phase 3). Clinicians collected data on standard ASPN reporting cards.


RESULTS
In Phase 1 the clinicians discussed alcohol during 9.6% of all visits. Seventy-three percent of those discussions were shorter than 2 minutes long, and only 10% lasted longer than 4 minutes. When routine screening was added (Phase 2), clinicians were more likely to discuss alcohol at acute-illness visits, but the frequency, duration, and intensity of such discussions did not change. Only 32% of Phase 2 discussions prompted by a positive screening result lasted longer than 2 minutes. After training, the duration increased (P <.004). In Phase 3, 58% of discussions prompted by a positive screening result lasted longer than 2 minutes, but only 26% lasted longer than 4 minutes.


CONCLUSIONS
Routine screening changed the kinds of visits during which clinicians discussed alcohol use. Training in brief-intervention techniques significantly increased the duration of alcohol-related discussions, but most discussions prompted by a positive screening result were still shorter than effective interventions reported in the literature.
Vinson
D C
DC
University of Missouri-Columbia, Family Medicine, 65212, USA. VinsonD@health.missouri.edu
Elder
N
N
Werner
J J
JJ
Vorel
L A
LA
Nutting
P A
PA
D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D002170:Canada; D005194:Family Practice / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D009722:Nurse Practitioners / Q000193:education* / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000193:education* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States