The effect of an educational intervention on alcohol consumption, at-risk drinking, and health care utilization in older adults: the Project SHARE study.
OBJECTIVE
The purpose of this study was to examine the effectiveness of a patient-provider educational intervention in reducing at-risk drinking among older adults.


METHODS
This was a cluster-randomized controlled trial of 31 primary care providers and their patients ages 60 years and older at a community-based practice with seven clinics. Recruitment occurred from July 2005 to August 2007. Eligibility was determined by telephone and a baseline mailed survey. A total of 1,186 at-risk drinkers were identified by the Comorbidity Alcohol Risk Evaluation Tool. Follow-up patient surveys were administered at 3, 6, and 12 months after baseline. Study physicians and their patients were randomly assigned to usual care (n = 640 patients) versus the Project SHARE (Senior Health and Alcohol Risk Education) intervention (n = 546 patients), which included personalized reports, educational materials, drinking diaries, physician advice during office visits, and telephone counseling delivered by a health educator. Main outcomes were alcohol consumption, at-risk drinking (overall and by type), alcohol discussions with physicians, health care utilization, and screening and intervention costs.


RESULTS
At 12 months, the intervention was significantly associated with an increase in alcohol-related discussions with physicians (23% vs. 13%; p ≤ .01) and reductions in at-risk drinking (56% vs. 67%; p ≤ .01), alcohol consumption (-2.19 drinks per week; p ≤ .01), physician visits (-1.14 visits; p = .03), emergency department visits (16% vs. 25%; p ≤ .01), and nonprofessional caregiving visits (12% vs. 17%; p ≤ .01). Average variable costs per patient were $31 for screening and $79 for intervention.


CONCLUSIONS
The intervention reduced alcohol consumption and at-risk drinking among older adults. Effects were sustained over a year and may have been associated with lower health care utilization, offsetting screening and intervention costs.
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, Department of Health Policy and Management, School of Public Health, University of California at Los Angeles, Los Angeles, California.
Susan L
SL
Ettner
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Haiyong
H
Xu
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
O Kenrik
OK
Duru
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Alfonso
A
Ang
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Chi-Hong
CH
Tseng
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, Ahava Center for Spiritual Living, Lexington, Kentucky (current affiliation).
Louise
L
Tallen
Department of Health Policy and Management, School of Public Health, University of California at Los Angeles, Los Angeles, California, Department of Healthcare Policy and Research, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (current affiliation).
Andrew
A
Barnes
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, Private practice, Los Angeles, California (current affiliation).
Michelle
M
Mirkin
Sansum Clinic, Santa Barbara, California.
Kurt
K
Ransohoff
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California at Los Angeles, Los Angeles, California.
Alison A
AA
Moore
D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000523:psychology / Q000628:therapy* / Q000639:trends; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods* / Q000639:trends; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology / Q000639:trends; D012307:Risk Factors; D012309:Risk-Taking; D016896:Treatment Outcome