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


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


METHODS
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.


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


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.
Bradley
Katharine A
KA
Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98108, USA. willi@u.washington.edu
Epler
Amee J
AJ
Bush
Kristen R
KR
Sporleder
Jennifer L
JL
Dunn
Christopher W
CW
Cochran
Nancy E
NE
Braddock
Clarence H
CH
McDonell
Mary B
MB
Fihn
Stephan D
SD
D000428:Alcohol Drinking / Q000523:psychology*; D000437:Alcoholism / Q000175:diagnosis*; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic; D011320:Primary Health Care; D015813:Substance Abuse Detection / Q000523:psychology*; D013637:Tape Recording; D014728:Veterans