Alcohol-related discussions in primary care - A report from ASPN

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.