Effectively incorporating brief intervention for unhealthy alcohol use into clinical practice remains a challenge. To evaluate a possible method of implementation, researchers randomly assigned 3 primary care practices (including 711 patients aged 65 or older who drank* and 23 physicians) to receive usual care or 1 of 2 interventions.

In both intervention groups, patients were mailed educational materials and personalized reports of their drinking risks and problems (based on a 10-minute screening interview). In one of the groups, doctors were also given the patient drinking reports. Researchers assessed alcohol use at baseline and 12 months later (665 subjects at follow-up) and adjusted analyses for potential confounders.

• At baseline, 52 percent of patients drank low-risk amounts, 26 percent drank risky amounts, and 21 percent drank risky amounts with alcohol-related health consequences. 
• At follow-up, the proportion who drank risky amounts with consequences decreased to 16 percent among patients who had been provided the drinking reports but whose doctors had not. It decreased to 18 percent among patients who, along with their doctors, had been provided the reports. These decreases significantly differed from the decrease seen in the usual care group. 
• Lower-risk drinking, but not drinking risky amounts, increased significantly in both intervention groups compared with the usual care group. 

Comments by Richard Saitz, MD, MPH:

A personalized report for elderly patients appeared to modestly reduce unhealthy alcohol use. The pre-intervention survey plus any additional time spent by patients and physicians on alcohol issues may limit widespread use of this intervention in clinical practice. Nonetheless, interventions like this that systematically identify and attend to patient problems show the greatest promise for addressing unhealthy alcohol use.

*at least one drink in the past 3 months

Reference:

Fink A, Elliott MN, Tsai M, et al.  An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc. 2005;53(11):1937-1943.

Reprinted with permission from Alcohol and Health: Current Evidence.