BACKGROUND I Problem drinking is common, and a 15-minute intervention can h
elp some patients reduce drinking to safe levels. Little is known, however,
about the frequency and duration of alcohol-related discussions in primary
care.
METHODS Nineteen clinicians in the Ambulatory Sentinel Practice Network (AS
PN) collected data about alcohol-related discussions for 1 week following t
heir usual office route (Phase 1) and for I week with the addition of routi
ne screening for problem drinking (Phase 7), Of those, 15 clinicians collec
ted data for a third week after receiving training in brief interventions w
ith problem drinkers (Phase 3), Clinicians collected data on standard ASPN
reporting cards.
RESULTS In Phase 1 the clinicians discussed alcohol during 9.6% of all visi
ts. Seventy-three percent of those discussions were shorter than 2 minutes
long, and only 10% lasted longer than 4 minute.. When routine screening was
added (Phase 2), clinicians were more likely to discuss alcohol at acute-i
llness visits, but the frequency. duration, and intensity of such discussio
ns did not change. Only 32% of Phase 2 discussions prompted by a positive s
creening result lasted longer than 2 minutes. After training, the duration
increased (P <.004). In Phase 3, 58% of discussions prompted by a positive
screening result lasted longer than 2 minutes, but only 26% lasted longer t
han 4 minutes.
CONCLUSIONS Routine screenings changed the kinds of visits during which cli
nicians the kinds of visits during which clinicians discussed alcohol use.
Training in brief-intervention techniques significantly increased the durat
ion of. alcohol-related discussions, but most discussions prompted by a pos
itive screening result were still shorter than effective interventions repo
rted in the literature.