title: Alcohol-related discussions during general medicine appointments of male VA patients who screen positive for at-risk drinking.
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.
  
  
  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.
authors.affiliation: Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98108, USA. willi@u.washington.edu
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.forename: Amee J
authors.initials: AJ
authors.lastname: Epler
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Bush
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sporleder
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Dunn
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Cochran
authors.forename: Clarence H
authors.initials: CH
authors.lastname: Braddock
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: 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