title: Psychosocial Interventions for Problem Alcohol Use in Primary Care Settings (PINTA): Baseline Feasibility Data.
abstract: OBJECTIVE
  Many individuals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care.
  
  
  METHODS
  Data on addiction care processes were collected by (1) reviewing clinical records (n = 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n = 106) and general practitioners (GPs) (n = 15).
  
  
  RESULTS
  Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who had positive screening results for problem alcohol use, five received a brief intervention by a GP and none were referred to specialist treatment. Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful, and dependent drinking to be 25% (n = 26), 6% (n = 6), and 16% (n = 17), respectively. The intraclass correlation coefficient (ICC) for the proportion of patients with negative AUDITs was 0.038 (SE = 0.01). The ICCs for screening, brief intervention, and/or referral to treatment (SBIRT) were 0.16 (SE = 0.014), -0.06 (SE = 0.017), and 0.22 (SE = 0.026), respectively. Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/no problem alcohol use. Regular use of primary care was evident, as 25% had visited their GP more than 12 times during the past 3 months.
  
  
  CONCLUSIONS
  Comparing clinical records with patients' experience of SBIRT can shed light on the process of care. Alcohol screening in people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority.
authors.forename: Jan
authors.initials: J
authors.lastname: Klimas
authors.forename: Anne
authors.initials: A
authors.lastname: Marie Henihan
authors.forename: Geoff
authors.initials: G
authors.lastname: McCombe
authors.forename: Davina
authors.initials: D
authors.lastname: Swan
authors.forename: Rolande
authors.initials: R
authors.lastname: Anderson
authors.forename: Gerard
authors.initials: G
authors.lastname: Bury
authors.forename: Colum
authors.initials: C
authors.lastname: Dunne
authors.forename: Eamon
authors.initials: E
authors.lastname: Keenan
authors.forename: Jean
authors.initials: J
authors.lastname: Saunders
authors.forename: Gillian Williams
authors.initials: GW
authors.lastname: Shorter
authors.forename: Bobby P
authors.initials: BP
authors.lastname: Smyth
authors.forename: Walter
authors.initials: W
authors.lastname: Cullen
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D015813:Substance Abuse Detection
chemical_list: D008691:Methadone
keywords: SBIRT; agonist treatment; alcohol; family medicine; implementation; methadone; opioids