An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration.
OBJECTIVE
The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation.


METHODS
Observational, retrospective cohort study using secondary clinical and administrative data.


METHODS
Thirty VA facilities.


METHODS
Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9-15 months later (n = 6210; 28%).


METHODS
Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking).


RESULTS
Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42-52%] and 48% (95% CI = 42-54%) for patients with and without documented brief intervention, respectively (P = 0.50).


CONCLUSIONS
During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.
Health Services Research and Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA.
Emily C
EC
Williams
Anna D
AD
Rubinsky
Laura J
LJ
Chavez
Gwen T
GT
Lapham
Stacey E
SE
Rittmueller
Carol E
CE
Achtmeyer
Katharine A
KA
Bradley
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011614:Psychotherapy, Brief / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
Alcohol; brief intervention; implementation; unhealthy alcohol use; veterans