Veterans Receiving Brief Intervention for Alcohol Misuse Rate VA Providers and Care Higher than Veterans without Intervention
BACKGROUND:
VA has implemented screening for unhealthy alcohol use with the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C) and, in 2007, instituted a national performance measure to incentivize the provision of brief intervention for all Veterans with AUDIT-C scores of >5. Thus, the VA healthcare system provides a unique opportunity to assess the relationship between receipt of brief intervention and patient-reported indicators of care quality. Investigators used data from the VA Survey of Healthcare Experiences of Patients (SHEP), an ongoing survey of Veterans receiving care at VA facilities, to identify VA outpatient survey responders from FY09 to FY11 who screened positive for unhealthy alcohol use (AUDIT-C scores >3 for women, >4 for men), and responded to questions assessing brief intervention and ratings of care (n=10,612). They then assessed whether patient-reported receipt of brief intervention (receiving alcohol-related advice from a provider in the previous year) was associated with patient-reported indicators of high care quality (patient ratings of their VA provider and overall VA healthcare), adjusting for respondent demographics, self-reported health status, and severity of unhealthy alcohol use.
FINDINGS:
- Among 10,612 Veterans who screened positive for unhealthy alcohol use, a higher proportion who reported receipt of a brief alcohol intervention, compared to those who did not, rated their provider (87% vs. 82%) and VA healthcare (83% vs. 76%) as high quality.
- Sixty-one percent of Veterans in this study screened positive for mild unhealthy alcohol use (AUDIT-C 3-5), and 21%, 11%, and 8% screened positive for moderate (AUDIT-C 6-7), severe (AUDIT-C 8-9), and very severe (AUDIT-C 10-12) unhealthy alcohol use, respectively.
- Of drinkers reporting unhealthy alcohol use, forty-four percent of Veterans reported receipt of a brief intervention for unhealthy alcohol use in the previous year.
- Overall, 84% and 79% of Veterans rated their provider and VA healthcare as high quality, respectively.
IMPLICATIONS:
- Although the literature suggests providers may be concerned that discussions of unhealthy alcohol use may negatively impact relationships with their patients, study findings do not support concerns that delivering alcohol-related advice adversely affects patients' perceptions of care.
LIMITATIONS:
- Findings may be confounded by unmeasured factors, such as characteristics of patient-provider relationships, patient-centeredness of providers, and overall quality of care.
- Results may be biased if respondents incorrectly reported or failed to report reciept of brief alcohol intervention.
AUTHOR/FUNDING INFORMATION:
This study was partly funded through VA/HSR&D's Quality Enhancement Research Initiative (QUERI). Dr. Williams was supported by an HSR&D Career Development Award. All authors are part of HSR&D's Center for Innovation for Veteran-Centered and Value-Driven Care co-located in Seattle, WA and Denver, CO.
Simonetti J, Lapham G, and Williams E. Association between Receipt of Brief Alcohol Intervention and Quality of Care among Veteran Outpatients with Unhealthy Alcohol Use. Journal of General Internal Medicine. February 18, 2015;e-pub ahead of print.
