Alcohol-Related Discussions in Primary Care

Limitations

The 19 clinicians who participated in both Phase 1 and Phase 2 were demonstrably different from the Phase 1—only participants. Their alcohol-related discussions were longer, and more of those discussions were triggered by clinician concern. Assuming that the physicians who did not participate in Phase 2 were similar to family physicians in general, our findings are likely to show greater clinician concern about problem drinking and longer alcohol-related discussions than would be true nationally.

Also, all our data were from physician self-reports. Patient report, chart review, or observation by a third person would probably demonstrate differences. Given the lag between encounters and data recording for some clinicians, recall of alcohol-related discussions may have faded, and even those clinicians who recorded data after each visit might have missed some. However, this would be true of data collection in all 3 phases of our study, and the magnitude of bias would be similar. Furthermore, the phases were not contiguous for any practice, and we doubt there were any substantial learning or fatigue effects that might have changed the accuracy of data collection from one phase to another.

Conclusions

Alcohol use is a common topic of discussion in primary care, and the clinicians in this study usually felt comfortable addressing it. The duration of these discussions, however, was almost always shorter than the effective brief interventions with problem drinkers in all published clinical trials. Whether a 2-minute intervention would be successful is a matter for future empirical research, but it is clear that either brief interventions need to be substantially shorter, or the approach to alcohol problems in primary care needs to be changed. Furthermore, it is clear that simply adding routine screening to primary care practice is not sufficient to change clinician behavior significantly. Screening with a single question, however, was almost universally acceptable to patients and did not increase discomfort for the clinicians. And training the clinicians in recognition of and brief intervention with problem drinkers was effective in increasing the duration of the discussions.

Acknowledgments

We received funding from the Alcoholic Beverage Medical Research Foundation. During the study, Dr. Vinson was supported by a Generalist Physician Faculty Scholars Program grant from the Robert Wood Johnson Foundation.