title: Effects of screening and brief intervention training on resident and faculty alcohol intervention behaviours: a pre- post-intervention assessment.
abstract: BACKGROUND
  Many hazardous and harmful drinkers do not receive clinician advice to reduce their drinking. Previous studies suggest under-detection and clinician reluctance to intervene despite awareness of problem drinking (PD). The Healthy Habits Project previously reported chart review data documenting increased screening and intervention with hazardous and harmful drinkers after training clinicians and implementing routine screening. This report describes the impact of the Healthy Habits training program on clinicians' rates of identification of PD, level of certainty in identifying PD and the proportion of patients given advice to reduce alcohol use, based on self-report data using clinician exit questionnaires.
  
  
  METHODS
  28 residents and 10 faculty in a family medicine residency clinic completed four cycles of clinician exit interview questionnaires before and after screening and intervention training. Rates of identifying PD, level of diagnostic certainty, and frequency of advice to reduce drinking were compared across intervention status (pre vs. post). Findings were compared with rates of PD and advice to reduce drinking documented on chart review.
  
  
  RESULTS
  1,052 clinician exit questionnaires were collected. There were no significant differences in rates of PD identified before and after intervention (9.8% vs. 7.4%, p = .308). Faculty demonstrated greater certainty in PD diagnoses than residents (p = .028) and gave more advice to reduce drinking (p = .042) throughout the program. Faculty and residents reported higher levels of diagnostic certainty after training (p = .039 and .030, respectively). After training, residents showed greater increases than faculty in the percentage of patients given advice to reduce drinking (p = .038), and patients felt to be problem drinkers were significantly more likely to receive advice to reduce drinking by all clinicians (50% vs. 75%, p = .047). The number of patients receiving advice to reduce drinking after program implementation exceeded the number of patients felt to be problem drinkers. Recognition rates of PD were four to eight times higher than rates documented on chart review (p = .028).
  
  
  CONCLUSIONS
  This program resulted in greater clinician certainty in diagnosing PD and increases in the number of patients with PD who received advice to reduce drinking. Future programs should include booster training sessions and emphasize documentation of PD and brief intervention.
authors.affiliation: Department of Family Medicine, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, GA 31210, USA. seale.paul@mccg.org
authors.forename: J Paul
authors.initials: JP
authors.lastname: Seale
authors.forename: Sylvia
authors.initials: S
authors.lastname: Shellenberger
authors.forename: John M
authors.initials: JM
authors.lastname: Boltri
authors.forename: I S
authors.initials: IS
authors.lastname: Okosun
authors.forename: Barbara
authors.initials: B
authors.lastname: Barton
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000517:prevention & control*; D002983:Clinical Competence; D003376:Counseling / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D005180:Faculty, Medical / Q000592:standards*; D005194:Family Practice / Q000193:education* / Q000592:standards; D005260:Female; D005845:Georgia; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011795:Surveys and Questionnaires