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An Early Evaluation of Implementation of Brief Intervention for Unhealthy Alcohol Use in the U.S. Veterans Health Administration

29 Apr 2014

Abstract
Aims

The U.S. Veterans Health Administration (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.

Design

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

Setting

30 VA facilities.

Participants

Outpatients who screened positive for unhealthy alcohol use (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=6,210; 28%).

Measurements

Multilevel 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).

Findings

Among 6,210 patients with follow-up alcohol screening, 1,751 (28%) had brief intervention and 2,922 (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 U.S. Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.

Date: 
29 April 2014

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