OBJECTIVE: This study describes primary care discussions with patients who screened positive for at-risk drinking. In addition, discussions
about alcohol use from 2 clinic firms, one with a provider-prompting intervention, are compared.
DESIGN: Cross-sectional analyses of audiotaped appointments collected over 6 months.
PARTICIPANTS AND SETTING: Male patients in a VA general medicine clinic were eligible if they screened positive for at-risk drinking and had a general
medicine appointment with a consenting provider during the study period. Participating patients (N=47) and providers (N=17) were enrolled in 1 of 2 firms in the clinic (Intervention or Control) and were blinded to the study focus.
INTERVENTION: Intervention providers received patient-specific results of positive alcohol-screening tests at each visit.
MEASURES AND MAIN RESULTS: Of 68 visits taped, 39 (57.4%) included any mention of alcohol. Patient and provider utterances during discussions about
alcohol use were coded using Motivational Interviewing Skills Codes. Providers contributed 58% of utterances during alcohol-related
discussions with most coded as questions (24%), information giving (23%), or facilitation (34%). Advice, reflective listening,
and supportive or affirming statements occurred infrequently (5%, 3%, and 5%, of provider utterances respectively). Providers
offered alcohol-related advice during 21% of visits. Sixteen percent of patient utterances reflected “resistance” to change
and 12% reflected readiness to change. On average, Intervention providers were more likely to discuss alcohol use than Control
providers (82.4% vs 39.6% of visits; P=.026).
CONCLUSIONS: During discussions about alcohol, general medicine providers asked questions and offered information, but usually did not
give explicit alcohol-related advice. Discussions about alcohol occurred more often when providers were prompted.
Key words alcohol - primary care - brief interventions - motivational interviewing
This research was supported by grants from the University of Washington Royalty Research Fund, and the Department of Veterans
Affairs, Health Services Research and Development Service (SDR 96-002). Dr. Bradley is an investigator at the VA Puget Sound
Health Care System, and is currently supported by National Institute of Alcohol Abuse and Alcoholism grant no. K23AA00313)
and is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Views expressed in this article are those of
the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington,
the National Institute of Alcohol Abuse and Alcoholism, or the Robert Wood Johnson Foundation.