title: Alcohol-related advice for Veterans Affairs primary care patients: Who gets it? Who gives it?
abstract: OBJECTIVE
  Most patients who misuse alcohol do not receive alcohol counseling from their providers. This study evaluated primary care patient and provider characteristics associated with receipt of alcohol-related advice and whether patients were advised to drink less or to abstain.
  
  
  METHODS
  Outpatients from seven Veterans Affairs (VA) general medicine clinics were eligible if they screened positive for alcohol misuse, completed the Alcohol Use Disorders Identification Test (AUDIT) and answered questions about alcohol-related treatment and advice. Hierarchical logistic regression was used to evaluate patient and provider characteristics associated with patient reports of alcohol-related advice from a primary care provider in the past year.
  
  
  RESULTS
  Among 5191 patients with alcohol misuse in the past year, 1554 (30%) reported receiving alcohol-related advice from their primary care provider during that time. Of patients advised, 73% reported advice to abstain. The likelihood of reporting advice increased as AUDIT scores increased: from 13% of patients with AUDIT scores <8 to 71% of those with scores > or =20. After adjustment for important confounders, measures reflecting the severity of alcohol misuse were most strongly associated with receipt of alcohol-related advice. Adjusted analyses also revealed increased odds of receiving advice among patients who reported liver disease, hypertension, current smoking or continuity of care. No measured provider characteristic was associated with giving advice in the fully adjusted model.
  
  
  CONCLUSIONS
  This multisite VA study found that most patients with alcohol misuse did not receive alcohol counseling from a primary care provider. Moreover, providers predominantly offered advice to abstain, and they appeared to focus on patients with the most severe problems due to drinking or medical contraindications to drinking.
authors.affiliation: Northwest Health Services Research and Development Center of Excellence, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108-1597, USA.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Burman
authors.forename: Daniel
authors.initials: D
authors.lastname: Kivlahan
authors.forename: Mara
authors.initials: M
authors.lastname: Buchbinder
authors.forename: Kristine
authors.initials: K
authors.lastname: Broglio
authors.forename: Xiao H
authors.initials: XH
authors.lastname: Zhou
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data; D037001:Directive Counseling / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data