title: PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use.
abstract: OBJECTIVE
  This study was part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly study (PRISM-E) and determined the relative effectiveness of two different models of care for reducing at-risk alcohol use among primary care patients aged 65 and older.
  
  
  METHODS
  This multisite study was a randomized clinical trial comparing integrated care with enhanced specialty referral for older primary care patients screened and identified to have at-risk drinking.
  
  
  RESULTS
  Before the study, the 560 participants consumed a mean of 17.9 drinks per week and had a mean of 21.1 binge episodes in the prior three months. At six months, both treatment groups reported lower levels of average weekly drinking (p<.001) and binge drinking (p<.001), despite low levels of treatment engagement. However, the declines did not differ significantly between treatment groups.
  
  
  CONCLUSIONS
  These results suggest that older persons with at-risk drinking can substantially modify their drinking over time. Although no evidence suggested that the model of care was important in achieving this result, the magnitude of reduction in alcohol use was comparable with other intervention studies.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Room 3002, Philadelphia, Pennsylvania 11104, USA. oslin@mail.med.upenn.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
authors.forename: Susan
authors.initials: S
authors.lastname: Grantham
authors.forename: Eugenie
authors.initials: E
authors.lastname: Coakley
authors.forename: James
authors.initials: J
authors.lastname: Maxwell
authors.forename: Keith
authors.initials: K
authors.lastname: Miles
authors.forename: James
authors.initials: J
authors.lastname: Ware
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.forename: Dean D
authors.initials: DD
authors.lastname: Krahn
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
authors.forename: Cynthia
authors.initials: C
authors.lastname: Zubritsky
authors.forename: Ed
authors.initials: E
authors.lastname: Olsen
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Kirchner
authors.forename: Sue
authors.initials: S
authors.lastname: Levkoff
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000517:prevention & control / Q000523:psychology; D000437:Alcoholism / Q000534:rehabilitation*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010348:Patient Care Team; D011320:Primary Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D013695:Temperance / Q000523:psychology