Screening and brief intervention for hazardous drinking in an HMO: Effects on medical care utilization (original) (raw)

Abstract

This study examined whether a brief intervention to reduce hazardous alcohol consumption among primary care patients reduced use of medical care. In a parent, randomized controlled trial, at-risk drinkers identified in HMO outpatient waiting rooms were randomly assigned to receive usual care or brief clinician advice plus a 15-minute motivational counseling session. The current study (_n_=514) examined the groups' use of outpatient and inpatient medical services during two years after intervention. Although the intervention reduced alcohol consumption at six-month follow-up, intervention and control groups made similar numbers of outpatient visits (_M_=17.7 vs. 18.3, respectively;_p_=.47), were equally likely to be hospitalized (21.2% vs. 22.0%;_p_=.81), and, among those hospitalized, had similar lengths of stay (4.7 vs. 6.6 days;_p_=.37). Although brief interventions to reduce hazardous drinking may potentially reduce medical care utilization, more evidence is needed to substantiate their practicality and cost-effectiveness.

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References

  1. Institute of Medicine:Broadening the Base of Treatment for Alcohol Problems. Washington, DC: National Academy Press, 1990.
    Google Scholar
  2. Cahalan D:Understanding America's Drinking Problem. San Francisco: Jossey-Bass, 1987.
    Google Scholar
  3. Moore MH, Gerstein DR (Eds.):Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington DC: National Academy Press, 1981.
    Google Scholar
  4. Ninth Special Report to the U.S. Congress on Alcohol and Health. NIH Pub. No. 97-4017. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 1997.
  5. Association for Health Services Research: The use of Alcohol in the United States.Frontlines, November 1996, p. 5.
  6. WHO Brief Intervention Study Group: A cross-national trial of brief interventions with heavy drinkers.American Journal of Public Health 1996; 86:948–955.
    Google Scholar
  7. Miller WR, Rollnick S:Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford, 1991.
    Google Scholar
  8. Bien TH, Miller WR, Tonigan JS: Brief interventions for alcohol problems: A review.Addiction 1993; 88:315–336.
    Google Scholar
  9. Wilk AI, Jensen NM, Havighurst TC: Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers.Journal of General Internal Medicine 1997; 12:274–283.
    Google Scholar
  10. Fleming MF, Barry KL, Manwell LB, et al.: Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community based primary care practices.Journal of the American Medical Association 1997; 277:1039–1045.
    Google Scholar
  11. Wallace P, Cutler S, Haines A: Randomized controlled trial of general practitioner intervention in patients with excessive alcohol consumption.British Medical Journal 1988; 297:663–668.
    Google Scholar
  12. Committee on Health Services Research, National Advisory Council on Alcohol Abuse and Alcoholism:Improving the Delivery of Alcohol Treatment and Prevention Services: Executive Summary. NIH Pub. No. 4224. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 1997.
    Google Scholar
  13. Holder HD, Blose JO: The reduction of health care costs associated with alcoholism treatment: A 14-year longitudinal study.Journal of Studies on Alcohol 1992; 53:293–302.
    Google Scholar
  14. Holder HD, Lennox RD, Blose JO: The economic benefits of alcoholism treatment: A summary of twenty years of research.Journal of Employee Assistance Research 1992; 1:63–82.
    Google Scholar
  15. Kristenson H, Ohlin H, Hulten-Nosslin M, et al.: Identification and intervention of heavy drinking in middle-aged men: Results and follow-up of 24–60 months of long-term study with randomized controls.Alcoholism: Clinical and Experimental Research 1983; 7:203–209.
    Google Scholar
  16. Babor TF, Steinberg KL: Screening for alcohol problems in an era of managed care: Beyond alcoholism or back to the future?Frontlines, November 1996, pp. 4–5.
  17. Peters J, Brooker C, McCabe C, et al.: Problems encountered with opportunistic screening for alcohol-related problems in patients attending an accident and emergency department.Addiction 1998; 93:589–594.
    Google Scholar
  18. Richmond RL, Anderson P: Research in general practice for smokers and excessive drinkers in Australia and the UK. II. Representiveness of the results.Addiction 1994; 89:41–47.
    Google Scholar
  19. Richmond RL, Anderson P: Research in general practice for smokers and excessive drinkers in Australia and the UK. III. Dissemination of interventions.Addiction 1994; 89:49–62.
    Google Scholar
  20. Senft RA, Polen MR, Freeborn DK, et al.: Brief intervention in a primary care setting for hazardous drinkers.American Journal of Preventive Medicine 1997; 13:464–470.
    Google Scholar
  21. Babor TF, Grant M: From clinical research to secondary prevention: International collaboration in the development of the alcohol use disorders identification test (AUDIT).Alcohol Health and Research World 1989; 13:371–374.
    Google Scholar
  22. Von Korff M, Wagner EH, Saunders K: A chronic disease score from automated pharmacy data.Journal of Clinical Epidemiology 1992; 45:197–203.
    Google Scholar
  23. Johnson RE, Hornbrook MC, Nichols GA: Replicating the chronic disease score (CDS) from automated pharmacy data.Journal of Clinical Epidemiology 1994; 47:1191–1199.
    Google Scholar
  24. Diehr P, Yanez D, Ash A, et al.: Methods for analyzing health care utilization and costs.Annual Review of Public Health 1999; 20:125–144.
    Google Scholar
  25. Edwards AG, Rollnick S: Outcome studies of brief alcohol intervention in general practice: The problem of lost subjects.Addiction 1997; 92:1699–1704.
    Google Scholar
  26. Fleming MF, Manwell LB, Barry KL, et al.: At-risk drinking in an HMO primary care sample: Prevalence and health policy implications.American Journal of Public Health 1998; 88:90–93.
    Google Scholar
  27. University of Connecticut Health Center:Reducing Risky Drinking through Screening and Brief Intervention. Farmington: University of Connecticut Health Center, 1997.
    Google Scholar

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Authors and Affiliations

  1. Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, 97227, Portland, OR
    Donald K. Freeborn Ph.D. (Senior Investigator), Michael R. Polen M.A. (senior research associate), Jack F. Hollis Ph.D. (associate director and senior investigator) & Robert A. Senft M.D. (adjunct investigator (at time of this study)

Authors

  1. Donald K. Freeborn Ph.D.
  2. Michael R. Polen M.A.
  3. Jack F. Hollis Ph.D.
  4. Robert A. Senft M.D.

Corresponding author

Correspondence toDonald K. Freeborn Ph.D..

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Freeborn, D.K., Polen, M.R., Hollis, J.F. et al. Screening and brief intervention for hazardous drinking in an HMO: Effects on medical care utilization.The Journal of Behavioral Health Services & Research 27, 446–453 (2000). https://doi.org/10.1007/BF02287826

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