Emily C Williams1, Gwen T Lapham2, Jennifer F Bobb3, Anna D Rubinsky4, Sheryl L Catz5, Susan M Shortreed6, Kara M Bensley7, Katharine A Bradley8. 1. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care (COIN), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: Williams3@va.gov. 2. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care (COIN), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: Lapham.g@ghc.org. 3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: bobb.j@ghc.org. 4. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care (COIN), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Kidney Health Research Collaborative, University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, United States. Electronic address: Anna.Rubinsky@va.gov. 5. Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: scatz@ucdavis.edu. 6. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Department of Biostatistics, University of Washington; Seattle, WA, United States. Electronic address: shortreed.s@ghc.org. 7. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care (COIN), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States. Electronic address: kbensley@uw.edu. 8. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care (COIN), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System - Seattle Division, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: Bradley.k@ghc.org.
Abstract
OBJECTIVE: Unhealthy alcohol use is particularly risky for patients living with HIV (PLWH). Brief interventions reduce drinking among patients with unhealthy alcohol use, but whether its receipt in routine outpatient settings is associated with reduced drinking among PLWH with unhealthy alcohol use is unknown. We assessed whether PLWH who screened positive for unhealthy alcohol use were more likely to resolve unhealthy drinking one year later if they had brief alcohol intervention (BI) documented in their electronic health record in a national sample of PLWH from the Veterans Health Administration. METHODS: Secondary VA clinical and administrative data from the electronic medical record (EMR) were used to identify all positive alcohol screens (AUDIT-C score≥5) documented among PLWH (10/01/09-5/30/13) followed by another alcohol screen documented 9-15months later. Unadjusted and adjusted Poisson regression models assessed the association between brief intervention (advice to reduce drinking or abstain documented in EMR) and resolution of unhealthy alcohol use (follow-up AUDIT-C<5 with ≥2 point reduction). RESULTS: Overall 2101 PLWH with unhealthy drinking (10/01/09-5/30/13) had repeat alcohol screens 9-15months later. Of those, 77% had brief intervention documented after their first screen, and 61% resolved unhealthy alcohol use at follow-up. Documented brief intervention was not associated with resolution [Adjusted incidence rate ratio 0.96, (95% CI 0.90-1.02)]. CONCLUSIONS: Documented brief intervention was not associated with resolving unhealthy alcohol use at follow-up screening among VA PLWH with unhealthy alcohol use. Effective methods of resolving unhealthy alcohol use in this vulnerable population are needed.
OBJECTIVE: Unhealthy alcohol use is particularly risky for patients living with HIV (PLWH). Brief interventions reduce drinking among patients with unhealthy alcohol use, but whether its receipt in routine outpatient settings is associated with reduced drinking among PLWH with unhealthy alcohol use is unknown. We assessed whether PLWH who screened positive for unhealthy alcohol use were more likely to resolve unhealthy drinking one year later if they had brief alcohol intervention (BI) documented in their electronic health record in a national sample of PLWH from the Veterans Health Administration. METHODS: Secondary VA clinical and administrative data from the electronic medical record (EMR) were used to identify all positive alcohol screens (AUDIT-C score≥5) documented among PLWH (10/01/09-5/30/13) followed by another alcohol screen documented 9-15months later. Unadjusted and adjusted Poisson regression models assessed the association between brief intervention (advice to reduce drinking or abstain documented in EMR) and resolution of unhealthy alcohol use (follow-up AUDIT-C<5 with ≥2 point reduction). RESULTS: Overall 2101 PLWH with unhealthy drinking (10/01/09-5/30/13) had repeat alcohol screens 9-15months later. Of those, 77% had brief intervention documented after their first screen, and 61% resolved unhealthy alcohol use at follow-up. Documented brief intervention was not associated with resolution [Adjusted incidence rate ratio 0.96, (95% CI 0.90-1.02)]. CONCLUSIONS: Documented brief intervention was not associated with resolving unhealthy alcohol use at follow-up screening among VA PLWH with unhealthy alcohol use. Effective methods of resolving unhealthy alcohol use in this vulnerable population are needed.
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