title: A Randomized Controlled Trial of IVR-Based Alcohol Brief Intervention to Promote Patient-Provider Communication in Primary Care.
abstract: Brief interventions for unhealthy drinking in primary care settings are efficacious, but underutilized. Efforts to improve rates of brief intervention though provider education and office systems redesign have had limited impact. Our novel brief intervention uses interactive voice response (IVR) to provide information and advice directly to unhealthy drinkers before a physician office visit, with the goals of stimulating in-office dialogue about drinking and decreasing unhealthy drinking. This automated approach is potentially scalable for wide application.
  
  
  
  We aimed to examine the effect of a pre-visit IVR-delivered brief alcohol intervention (IVR-BI) on patient-provider discussions of alcohol during the visit.
  
  
  
  This was a parallel group randomized controlled trial with two treatment arms: 1) IVR-BI or 2) usual care (no IVR-BI).
  
  
  
  In all, 1,567 patients were recruited from eight university medical center-affiliated internal medicine and family medicine clinics.
  
  
  
  IVR-BI is a brief alcohol intervention delivered by automated telephone. It has four components, based on the intervention steps outlined in the National Institute of Alcohol Abuse and Alcoholism guidelines for clinicians: 1) ask about alcohol use, 2) assess for alcohol use disorders, 3) advise patient to cut down or quit drinking, and 4) follow up at subsequent visits.
  
  
  
  Outcomes were patient reported: patient-provider discussion of alcohol during the visit; patient initiation of the discussion; and provider's recommendation about the patient's alcohol use.
  
  
  
  Patients randomized to IVR-BI were more likely to have reported discussing alcohol with their provider (52 % vs. 44 %, p = 0.003), bringing up the topic themselves (20 % vs. 12 %, p < 0.001), and receiving a recommendation (20 % vs. 14 %, p < 0.001). Other predictors of outcome included baseline consumption, education, age, and alcohol use disorder diagnosis.
  
  
  
  Providing automated brief interventions to patients prior to a primary care visit promotes discussion about unhealthy drinking and increases specific professional advice regarding changing drinking behavior.
authors.affiliation: Department of Psychiatry, The University of Vermont , Mail Stop #457 OH3, 1 So. Prospect St., Burlington, VT, 05401, USA. gail.rose@uvm.edu.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Rose
authors.affiliation: Department of Medical Biostatistics, The University of Vermont, Burlington, VT, USA.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Badger
authors.affiliation: Department of Medical Biostatistics, The University of Vermont, Burlington, VT, USA.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Skelly
authors.affiliation: Department of Research Administrative Services, Harvard University, Cambridge, MA, USA.
authors.forename: Tonya A
authors.initials: TA
authors.lastname: Ferraro
authors.affiliation: Department of Medicine, The University of Vermont, Burlington, VT, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: MacLean
authors.affiliation: Department of Psychiatry, The University of Vermont , Mail Stop #457 OH3, 1 So. Prospect St., Burlington, VT, 05401, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Helzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000517:prevention & control / Q000523:psychology*; D000437:Alcoholism / Q000517:prevention & control / Q000523:psychology; D003142:Communication; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D000066908:Simulation Training / Q000379:methods*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: alcohol consumption; automated intervention; automated telephone; brief intervention; interactive voice response; patient engagement; physician–patient relations; primary care