Evaluation of an electronic clinical reminder to facilitate brief alcohol-counseling interventions in primary care.
OBJECTIVE
Brief intervention for patients with unhealthy alcohol use is a prevention priority in the United States, but most eligible patients do not receive it. This study evaluated an electronic alcohol-counseling clinical reminder at a single Veterans Affairs general medicine clinic.


METHODS
The systems-level intervention evaluated in this study consisted of making the clinical reminder, which facilitated medical record documentation of brief intervention among patients who screened positive for unhealthy alcohol use, available to providers on one (of two) randomly selected hallways. Secondary electronic data were extracted for all patients who visited the clinic (October 1, 2002, to September 30, 2005). The proportion of patients with clinical-reminder use was evaluated among patients who screened positive for unhealthy drinking and were assigned to intervention hallway providers ("descriptive cohort"). Adjusted logistic regression evaluated the association between the intervention and resolution of unhealthy drinking at follow-up among all screen-positive patients who completed a second Alcohol Use Disorders Identification Test Consumption questionnaire 18 months or longer after the first ("outcomes cohort").


RESULTS
Eligible patients (N= 22,863) included 10,392 controls and 12,471 in the intervention group. Fifteen percent (398 of 2,640) of descriptive cohort patients with unhealthy drinking had clinical-reminder use, which varied by severity (14% [n = 302 of 2,165] with mild/moderate and 20% [n = 96 of 475] with severe unhealthy drinking,p = .001). Only 39% (156 of 398) of patients with clinical-reminder use had documented brief intervention; advice to abstain was most common. Access to the clinical reminder was not significantly associated with resolution of unhealthy drinking in 1,358 patients in the outcomes cohort.


CONCLUSIONS
Availability of a clinical reminder to facilitate brief intervention did not, alone, result in substantial use of the clinical reminder. More active implementation efforts may be needed to get brief interventions onto the agenda of busy primary care providers.
Williams
Emily C
EC
Health Services Research and Development and Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, Washington 98101, USA. emily.williams3@va.gov
Achtmeyer
Carol E
CE
Kivlahan
Daniel R
DR
Greenberg
Diane
D
Merrill
Joseph O
JO
Wickizer
Thomas M
TM
Koepsell
Thomas D
TD
Heagerty
Patrick J
PJ
Bradley
Katharine A
KA
D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D015331:Cohort Studies; D037001:Directive Counseling / Q000379:methods / Q000592:standards*; D034742:Electronic Mail / Q000592:standards*; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D017010:Reminder Systems / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome