Advertisement

Alcohol Screening and Brief Intervention: Office-Based Primary Care Physicians, U.S., 2015–2016

Published:November 10, 2021DOI:https://doi.org/10.1016/j.amepre.2021.07.013

      Introduction

      In 2013, the U.S. Preventive Services Task Force again recommended alcohol misuse screening and provision of brief behavioral counseling interventions to those engaged in risky drinking for all adults aged ≥18 years in primary care. This report presents national estimates of the provision of alcohol screening and brief intervention by U.S. primary care physicians, the screening methods, and the resources they identified as helpful in implementing alcohol/substance screening and intervention in primary care settings.

      Methods

      Data included 876 self-identified primary care physicians from the Physician Induction Interview portion of the 2015–2016 National Ambulatory Medical Care Survey, an annual nationally representative sample survey of nonfederal, office-based physicians in the U.S., encompassing all the 50 states and the District of Columbia. Descriptive estimates (annualized percentages) of alcohol misuse screening were generated for selected primary care physician characteristics. Estimates of how primary care physicians reported screening, the frequency of brief intervention, and resources identified as helpful in the implementation of screening/intervention procedures were also generated. Two-tailed significance tests were used to determine the differences between the compared groups. Data analyses were conducted in 2019–2021.

      Results

      In total, 71.7% of office-based primary care physicians reported screening patients for alcohol misuse. Statistically significant differences in screening were observed geographically and by provider specialty.

      Conclusions

      Less than 40% of primary care physicians who screened patients for alcohol misuse reported always intervening with patients who screened positive for risky alcohol use. Collection of data on resources that primary care physicians report as being helpful for alcohol/substance screening and intervention implementation may be useful in continuous improvement efforts.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Bouchery EE
        • Harwood HJ
        • Sacks JJ
        • Simon CJ
        • Brewer RD.
        Economic costs of excessive alcohol consumption in the U.S., 2006. [published correction appears in Am J Prev Med. 2013;44(2):198].
        Am J Prev Med. 2011; 41: 516-524https://doi.org/10.1016/j.amepre.2011.06.045
        • HHS, U.S. Department of Agriculture
        2015–2020 Dietary guidelines for Americans.
        8th Edition. HHS, U.S. Department of Agriculture, Washington, DCDecember 2015 (Published)
        • Esser MB
        • Sherk A
        • Liu Y
        • et al.
        Deaths and years of potential life lost from excessive alcohol use - United States, 2011-2015.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1428-1433https://doi.org/10.15585/mmwr.mm6939a6
        • Sacks JJ
        • Gonzales KR
        • Bouchery EE
        • Tomedi LE
        • Brewer RD.
        2010 National and state costs of excessive alcohol consumption.
        Am J Prev Med. 2015; 49: e73-e79https://doi.org/10.1016/j.amepre.2015.05.031
      1. Excessive alcohol use.
        Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2019 (Updated)
        • Schuchat A.
        The CDC’s recommendations to help prevent fetal alcohol spectrum disorders.
        Am Fam Physician. 2017; 95: 6-7
        https://www.aafp.org/afp/2017/0101/p6.html
        Date accessed: October 8, 2021
        • Jonas DE
        • Garbutt JC
        • Amick HR
        • et al.
        Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2012; 157: 645-654https://doi.org/10.7326/0003-4819-157-9-201211060-00544
        • O'Connor EA
        • Perdue LA
        • Senger CA
        • et al.
        Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: updated evidence report and systematic review for the U.S. Preventive Services Task Force.
        JAMA. 2018; 320: 1910-1928https://doi.org/10.1001/jama.2018.12086
        • U.S. Preventive Services Task Force
        Final recommendation statement: alcohol misuse: screening and behavioral counseling interventions in primary care.
        U.S. Preventive Services Task Force, Rockville, MD2013 (Published May 15, 2013. Accessed August 23, 2021)
        • McKnight-Eily LR
        • Okoro CA
        • Turay K
        • Acero C
        • Hungerford D.
        Screening for alcohol use and brief counseling of adults −13 states and the District of Columbia, 2017.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 265-270https://doi.org/10.15585/mmwr.mm6910a3
        • McKnight-Eily LR
        • Liu Y
        • Brewer RD
        • et al.
        Vital signs: communication between health professionals and their patients about alcohol use–44 states and the District of Columbia, 2011.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 16-22
        • National Center for Health Statistics
        2015 NAMCS micro-data file documentation.
        National Center for Health Statistics, Hyattsville, MD2017 (Accessed October 4, 2021)
        • National Center for Health Statistics
        2016 NAMCS micro-data file documentation.
        National Center for Health Statistics, Hyattsville, MD2019 (Accessed September 9, 2021)
        • National Center for Health Statistics
        National Ambulatory Medical Care Survey 2015 Panel: Physician Induction Interview Sample Card (Form NAMCS-1A).
        National Center for Health Statistics, Hyattsville, MD2015 (Accessed September 9, 2021)
        • Sokol RJ
        • Martier SS
        • Ager JW.
        The T-ACE questions: practical prenatal detection of risk-drinking.
        Am J Obstet Gynecol. 1989; 160: 863-870https://doi.org/10.1016/0002-9378(89)90302-5
        • Russell M.
        New assessment tools for risk drinking during pregnancy: T-ACE, TWEAK, and Others.
        Alcohol Health Res World. 1994; 18: 55-61
        • Ewing JA.
        Detecting alcoholism. The CAGE Questionnaire.
        JAMA. 1984; 252: 1905-1907https://doi.org/10.1001/jama.252.14.1905
        • Knight JR
        • Shrier LA
        • Bravender TD
        • Farrell M
        • Vander Bilt J
        • Shaffer HJ
        A new brief screen for adolescent substance abuse.
        Arch Pediatr Adolesc Med. 1999; 153: 591-596https://doi.org/10.1001/archpedi.153.6.591
        • Harris SK
        • Knight JR
        • Van Hook S
        • et al.
        Adolescent substance use screening in primary care: validity of computer self-administered versus clinician-administered screening.
        Subst Abus. 2016; 37: 197-203https://doi.org/10.1080/08897077.2015.1014615
        • Saunders JB
        • Aasland OG
        • Babor TF
        • de la Fuente JR
        • Grant M.
        Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II.
        Addiction. 1993; 88: 791-804https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
        • Korn EL
        • Graubard BI.
        Confidence intervals for proportions with small expected number of positive counts estimated from survey data.
        Surv Methodol. 1998; 24: 193-201
        • Parker JD
        • Talih M
        • Malec DJ
        • et al.
        National Center for Health Statistics data presentation standards for proportions.
        Vital Health Stat. 2017; 2: 1-22
        https://stacks.cdc.gov/view/cdc/47786
        Date accessed: September 9, 2021
      2. AGOG Committee Opinion No. 473: substance abuse reporting and pregnancy: the role of the obstetrician–gynecologist.
        Obstet Gynecol. 2011; 117: 200-201https://doi.org/10.1097/AOG.0b013e31820a6216
        • Denny CH
        • Acero CS
        • Naimi TS
        • Kim SY.
        Consumption of alcohol beverages and binge drinking among pregnant women aged 18–44 years - United States, 2015-2017.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 365-368https://doi.org/10.15585/mmwr.mm6816a1
      3. Crude percentages of current, regular alcohol consumption for adults aged 18 and over, United States, 2015–2018.
        National Health Interview Survey. Generated interactively. National Center for Health Statistics., June 23, 2021 (Accessed September 9, 2021)
        • Tan CH
        • Hungerford DW
        • Denny CH
        • McKnight-Eily LR.
        Screening for alcohol misuse: practices among U.S. primary care providers, DocStyles 2016.
        Am J Prev Med. 2018; 54: 173-180https://doi.org/10.1016/j.amepre.2017.11.008
        • Partnership to End Addiction
        Addiction medicine: closing the gap between science and practice.
        Partnership to End Addiction, New York, NYJune 2012 (Accessed June 15, 2021)
        • Liu J
        • Rainis D
        • Strohmeyer J
        • et al.
        Screening and follow-up for unhealthy alcohol use: quality improvement change package for health plans.
        National Committee for Quality Assurance, Washington, DC2020 (Accessed October 1, 2020)
        • Rosário F
        • Vasiljevic M
        • Pas L
        • Fitzgerald N
        • Ribeiro C.
        Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial.
        Fam Pract. 2019; 36: 199-205https://doi.org/10.1093/fampra/cmy062