Addressing alcohol problems in primary care: a cluster randomized, controlled trial of a systems intervention. The screening and intervention in primary care (SIP) study.
BACKGROUND
Screening and intervention for alcohol problems can reduce drinking and its consequences but are often not implemented.


OBJECTIVE
To test whether providing physicians with patients' alcohol screening results and simple individualized recommendations would affect the likelihood of a physician's having a discussion with patients about alcohol during a primary care visit and would affect subsequent alcohol use.


METHODS
Cluster randomized, controlled trial.


METHODS
Urban academic primary care practice.


METHODS
41 faculty and resident primary care physicians and 312 patients with hazardous drinking.


METHODS
Providing physicians with alcohol screening results (CAGE questionnaire responses, alcohol consumption, and readiness to change) and recommendations for their patients at a visit.


METHODS
Patient self-report of discussions about alcohol use immediately after the physician visit and alcohol use 6 months later.


RESULTS
Of 312 patients, 240 visited faculty physicians, 301 (97%) completed the outcome assessment after the office visit, and 236 (76%) were followed for 6 months. Faculty physicians in the intervention group tended to be more likely than faculty physicians in the control group to give patients advice about drinking (adjusted proportion, 64% [95% CI, 47% to 79%] vs. 42% [CI, 33% to 53%]) and to discuss problems associated with alcohol use (74% [CI, 59% to 85%] vs. 51% [CI, 39% to 62%]). Resident physicians' advice and discussions did not differ between groups. Six months later, patients who saw resident physicians in the intervention group had fewer drinks per drinking day (adjusted mean number of drinks, 3.8 [CI, 1.9 to 5.7] versus 11.6 [CI, 5.4 to 17.7]).


CONCLUSIONS
Although effects seem to differ by physician level of training, prompting physicians with alcohol screening results and recommendations for action can modestly increase discussions about alcohol use and advice to patients and may decrease alcohol consumption.
Saitz
Richard
R
Boston University and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, Massachusetts 02118-2393, USA. rsaitz@bu.edu
Horton
Nicholas J
NJ
Sullivan
Lisa M
LM
Moskowitz
Mark A
MA
Samet
Jeffrey H
JH
D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D000437:Alcoholism / Q000175:diagnosis / Q000517:prevention & control*; D002983:Clinical Competence; D016000:Cluster Analysis; D003376:Counseling; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010821:Physicians, Family; D011795:Surveys and Questionnaires