Training primary care clinicians in maintenance care for moderated alcohol use.
OBJECTIVE
To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior.


METHODS
We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 (1/4) hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients' visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have "made a change in their drinking and are trying to keep it that way"; and that they drank <15 (men) or <10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician's actions during the visit.


RESULTS
Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit.


CONCLUSIONS
Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians' inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry.
Friedmann
Peter D
PD
Program to Integrate Psychosocial and Health Services, Research Service, Providence Veterans Affairs Medical Center, Providence, RI, USA. pfriedmann@lifespan.org
Rose
Jennifer
J
Hayaki
Jumi
J
Ramsey
Susan
S
Charuvastra
Anthony
A
Dubé
Catherine
C
Herman
Debra
D
Stein
Michael D
MD
D000437:Alcoholism / Q000628:therapy*; D003463:Cues; D004502:Education, Medical, Continuing; D006801:Humans; D008499:Medical Records; D010821:Physicians, Family / Q000193:education*; D011159:Population Surveillance; D011364:Professional Practice; D040242:Risk Reduction Behavior; D055502:Secondary Prevention