Marianne Pugatch1, Grace Chang2, Deborah Garnick3, Mary Brolin3, Deborah Brief4, Christopher Miller5, Jerry Fleming6, Daryl Blaney7, Brian Harward8, Dominic Hodgkin3. 1. Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Boston, MA, USA; VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA. Electronic address: marianne.pugatch@ucsf.edu. 2. VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 3. Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA. 4. VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA. 5. VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 6. VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA. 7. VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA; Boston Medical Center, Boston, MA, USA. 8. Walden University, Minneapolis, MN, USA.
Abstract
BACKGROUND: Approximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3-4; =5-7; =8-12), and the role of alcohol risk level and other factors in predicting receipt of BI. METHODS: From administrative data (2010-2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not. RESULTS: While almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems. CONCLUSIONS: Given that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.
BACKGROUND: Approximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3-4; =5-7; =8-12), and the role of alcohol risk level and other factors in predicting receipt of BI. METHODS: From administrative data (2010-2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not. RESULTS: While almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems. CONCLUSIONS: Given that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.
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