title: Use of an electronic clinical reminder for brief alcohol counseling is associated with resolution of unhealthy alcohol use at follow-up screening.
abstract: OBJECTIVE
  Brief alcohol counseling is a foremost US prevention priority, but no health-care system has implemented it into routine care. This study evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling ("reminder"). The specific aims were to (1) determine the prevalence of use of the reminder and (2) evaluate whether use of the reminder was associated with resolution of unhealthy alcohol use at follow-up screening.
  
  
  METHODS
  The reminder was implemented in February 2004 in eight VA clinics where providers routinely used clinical reminders. Patients eligible for this retrospective cohort study screened positive on the AUDIT-C alcohol screening questionnaire (February 2004-April 2006) and had a repeat AUDIT-C during the 1-36 months of follow-up (mean 14.5). Use of the alcohol counseling clinical reminder was measured from secondary electronic data. Resolution of unhealthy alcohol use was defined as screening negative at follow-up with a >/=2-point reduction in AUDIT-C scores. Logistic regression was used to identify adjusted proportions of patients who resolved unhealthy alcohol use among those with and without reminder use.
  
  
  RESULTS
  Among 4,198 participants who screened positive for unhealthy alcohol use, 71% had use of the alcohol counseling clinical reminder documented in their medical records. Adjusted proportions of patients who resolved unhealthy alcohol use were 31% (95% CI 30-33%) and 28% (95% CI 25-30%), respectively, for patients with and without reminder use (p-value = 0.031).
  
  
  CONCLUSIONS
  The brief alcohol counseling clinical reminder was used for a majority of patients with unhealthy alcohol use and associated with a moderate decrease in drinking at follow-up.
authors.affiliation: Northwest Center of Excellence for Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. emily.williams3@va.gov
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Gwen
authors.initials: G
authors.lastname: Lapham
authors.forename: Carol E
authors.initials: CE
authors.lastname: Achtmeyer
authors.forename: Bryan
authors.initials: B
authors.lastname: Volpp
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology / Q000628:therapy*; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017010:Reminder Systems / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs