Alcohol screening and brief intervention at the US health service for ex-military personnel

Latest additions to the Effectiveness Bank all concern alcohol screening and brief intervention and derive from the US ‘VA’ health service for ex-military personnel. It trialled a computerised prompt to remind clinicians to consider advice or referral when a patient has screened positive for risky drinking. Where responding to such prompts was expected, they had the desired impact (entry 1) but not at other VA services (entry 2); leadership commitment seemed the essential ingredient. The third entry raised serious questions about the screening which determined whether the prompts would appear. Finally, for convenience we repeat two earlier entries, one thoughtfully (entry 4) analysing how to measure the performance of these systems and the last (entry 5) a review from the same VA research team of how to implement primary care alcohol screening and brief intervention.

Electronic prompts mean more primary care patients get advised about drinking
When a patient has screened positive for risky drinking, up pops a computerised prompt to remind the clinician to consider counselling. In one service for US ex-military personnel, this resulted in nearly three quarters of patients being counselled and a hint of consequentially reduced drinking; at another (entry below), findings were negative.

Leadership commitment needed to implement electronic alcohol advice prompts
At another service for US ex-military personnel the same reminder system was rarely used and made no difference to patients’ drinking. Lack of leadership commitment and incentives seemed the explanation.

Most risky drinkers missed in primary care because patients underreport drinking
61% of VA patients who screened positive for risky drinking when sent a postal survey did not do so when the same questions were asked at their clinics, casting doubt on the validity of screening in routine practice in services where the emphasis is more on quantity than quality of screening.

How to assess progress in implementing screening and brief alcohol interventions
Having mandated universal screening for alcohol problems, the US health system for ex-military personnel here thoughtfully addresses how to measure the degree to which this led to appropriate implementation of brief interventions, an essential step in driving up coverage.

What it takes to implement alcohol screening and brief intervention
Mapping the strategies trialled in attempts to implement screening and counselling for risky drinking primary care patients gives some clues to what it has taken to achieve a high screening rate. Less clear is what it takes to counsel a high proportion of positive screen patients. The framework used in the review could help reveal gaps in UK implementation efforts.

Sent by the Drug and Alcohol Findings Effectiveness Bank to alert you to site updates and UK-relevant evaluations and reviews of drug/alcohol interventions. Managed by DrugScope, Alcohol Concern and the National Addiction Centre. Supported by Alcohol Research UK and the J. Paul Getty Jr. Charitable Trust.