title: Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions.
abstract: Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey.
  
  
  
  This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP; 2007-2011) who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C ≥ 5) was estimated for each year.
  
  
  
  Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last.
  
  
  
  The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation.
authors.affiliation: Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Chavez
authors.affiliation: Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.|Department of Health Services, University of Washington, Seattle, Washington.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.|Group Health Research Institute, Seattle, Washington.
authors.forename: Gwen T
authors.initials: GT
authors.lastname: Lapham
authors.affiliation: Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.|Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.affiliation: Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.|Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.affiliation: Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.|Department of Health Services, University of Washington, Seattle, Washington.|Group Health Research Institute, Seattle, Washington.|Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington.|Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health