The effect of screening and brief intervention for risky drinking on health care utilization in managed care organizations.
OBJECTIVE
We sought to estimate the effect of screening and brief intervention (SBI) for risky alcohol use on the health care utilization of risky drinkers in 4 managed care organizations.


METHODS
A quasi-experimental group design was implemented in which 12 participating primary care clinics randomly were assigned to 1 of 3 study conditions. In one condition, physicians, physician assistants, and nurse practitioners delivered the brief intervention. In another condition, midlevel professionals (usually nurses) performed the brief intervention. In the third condition, SBI was not performed. Using administrative claims data, we estimated the effect of SBI on individual-level annual days of total and inpatient health care utilization; annual outpatient visits; annual emergency room visits; and annual visits related to alcohol, drug, or mental health conditions. Negative binomial regression models were used to control for other factors that may affect health care utilization.


RESULTS
Across all categories of care, the pre- to postintervention change in average health care utilization among risky drinkers in the intervention clinics was not significantly different from that of risky drinkers in the comparison clinics.


CONCLUSIONS
Our findings suggest that there is no effect of SBI on the health care utilization of risky drinkers in the year following the intervention. Although SBI does not appear to reduce health care utilization, previous studies find that it significantly reduces the alcohol consumption of risky drinkers. Because these reductions presumably improve patients' overall health and well-being, managed care organizations may still find it beneficial to implement SBI on a broad scale.
Bray
Jeremy W
JW
RTI International, Research Triangle Park, North Carolina 27709, USA. bray@rti.org
Zarkin
Gary A
GA
Davis
Keith L
KL
Mitra
Debanjali
D
Higgins-Biddle
John C
JC
Babor
Thomas F
TF
D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008605:Mental Health Services / Q000706:statistics & numerical data