Patient-centered primary care and receipt of evidence-based alcohol-related care in the national Veterans Health Administration.

Edmonds AT, Rhew IC, Jones-Smith J, Chan KCG, Nelson K, Williams EC. Patient-centered primary care and receipt of evidence-based alcohol-related care in the national Veterans Health Administration. Journal of substance abuse treatment. 2022 Jul 1; 138:108709.

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Abstract:

BACKGROUND: Health care systems are increasingly integrating screening and care for unhealthy alcohol use into primary care settings. However, gaps remain in receipt of evidence-based care after the detection of unhealthy alcohol use. Patient-centered primary care may be an important determinant of alcohol-related care receipt, but its role is underexamined. METHODS: We examined associations between previously developed, clinic-level measures of patient-centered care (indicative of medical home model implementation) and receipt of alcohol-related care in a national cohort of VA patients who screened positive for unhealthy alcohol use (defined by AUDIT-C alcohol screen of = 5; n  =  568,909) for whom brief intervention is recommended. We also assessed alcohol-related care in a subsample of these patients with a past-year alcohol use disorder (AUD) diagnosis (n  =  144,511) for whom specialty addictions care and medications are recommended. The study used modified Poisson models to assess associations between measures of patient-centered care and individual-level receipt of recommended alcohol-related care. We presented prevalence ratios (PR) and marginal probabilities to illustrate relative and absolute differences, respectively, in outcomes associated with clinic-level measures. RESULTS: Compared to patients in the lowest-ranked clinics, patients were more likely to receive brief intervention in clinics with the highest rankings of self-management support (PR: 1.06; 95% CI: 1.10, 1.11), communication (PR: 1.08; 95% CI: 1.04, 1.12), access (PR: 1.11; 95% CI: 1.06, 1.17), and care coordination (PR: 1.09; 95% CI: 1.03, 1.15). The study also observed a greater likelihood of receiving AUD medications among those receiving care at clinics with higher ratings of comprehensiveness (PR: 1.35; 95% CI: 1.10, 1.66) and shared decision-making (PR: 1.35; 95% CI: 1.12, 1.61); higher clinic-level access ratings were associated with specialty addictions care (PR: 1.15; 95% CI: 1.00, 1.32). Patients in the clinics with the highest summary patient-centered care ratings, compared to the lowest, had higher likelihoods of receiving brief intervention (PR: 1.07; 95% CI: 1.03, 1.12) and medications (PR: 1.16; 95% CI: 1.00, 1.35). The study did not identify any other statistically significant findings. CONCLUSIONS: This observational study found that dimensions of patient-centered care were associated with increased receipt of recommended alcohol-related care. Future studies should investigate strategies to improve patients'' experience of alcohol-related care.