Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: does it work?

BACKGROUND: There is a need for primary care providers to have brief effective methods to intervene with high-risk drinkers during a regular outpatient visit. OBJECTIVE: To determine whether brief physician- and nurse practitioner-delivered counseling intervention is efficacious as part of routine primary care in reducing alcohol consumption by high-risk drinkers. METHODS: Academic medical center-affiliated primary care practice sites were randomized to special intervention or to usual care. From a screened population of 9772 patients seeking routine medical care with their primary care providers, 530 high-risk drinkers were entered into the study. Special intervention included training providers in a brief (5- to 10-minute) patient-centered counseling intervention, and an office support system that screened patients, cued providers to intervene, and made patient education materials available. The primary outcome measures were change in alcohol use from baseline to 6 months as measured by weekly alcohol consumption and frequency of binge drinking episodes. RESULTS: Participants in the special intervention and usual care groups were similar on important background variables and potential confounders except that special intervention participants had significantly higher baseline levels of alcohol usage (P = .01). At 6-month follow-up, in the 91% of the cohort who provided follow-up information, alcohol consumption was significantly reduced when adjusted for age, sex, and baseline alcohol usage (special intervention, -5.8 drinks per week; usual care, -3.4 drinks per week; P = .001). CONCLUSIONS: This study provides evidence that screening and very brief (5- to 10-minute) advice and counseling delivered by a physician or nurse practitioner as part of routine primary care significantly reduces alcohol consumption by high-risk drinkers.

Provider training for patient-centered alcohol counseling in a primary care setting.

OBJECTIVE: To assess the impact of a brief training program on primary care providers' skills, attitudes, and knowledge regarding high-risk and problem drinking. DESIGN: Training plus pretesting and posttesting for program efficacy. SETTING: Ambulatory primary care clinic; academic medical center. PARTICIPANTS: Fourteen attending physicians, 12 residents, and 5 nurse practitioners were randomized by clinical team affiliation to a Special Intervention or usual care condition of a larger study. We report the results of the training program for the Special Intervention providers. INTERVENTION: Providers received a 2-hour group training session plus a 10- to 20-minute individual tutorial session 2 to 6 weeks after the group session. The training focused on teaching providers how to perform patient-centered counseling for high-risk and problem drinkers. MAIN OUTCOME MEASURES: Alcohol counseling skills; attitudes regarding preparedness to intervene and perceived importance and usefulness of intervening with high-risk and problem drinkers; and knowledge of the nature, prevalence, and appropriate treatment of alcohol abuse in primary care populations. RESULTS: After training, providers scored significantly higher on measures of counseling skills, preparedness to intervene, perceived usefulness and importance of intervening, and knowledge. CONCLUSION: A group training program plus brief individual feedback can significantly improve primary care providers' counseling skills, attitudes, and knowledge regarding high-risk and problem drinkers.