Abstract
BACKGROUNDApproximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention.OBJECTIVEWe aimed to determine primary care residents’ current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI).DESIGNThis was a multi-site, cross-sectional survey conducted from March 2010 through December 2012.PARTICIPANTSWe invited all residents in six primary care residency programs (three internal medicine programs and three family medicine programs) to participate. Of 244 residents, 210 completed the survey (response rate 86 %).MAIN MEASURESOur survey assessed residents’ alcohol screening practices (instruments used and frequency of screening), perceived barriers to discussing alcohol, brief intervention content, and self-rated ability to help hazardous drinkers. To determine the quality of brief interventions delivered, we examined how often residents reported including the three key recommended elements of feedback, advice, and goal-setting.KEY RESULTSMost residents (60 %, 125/208) reported “usually” or “always” screening patients for alcohol misuse at the initial clinic visit, but few residents routinely screened patients at subsequent acute-care (17 %, 35/208) or chronic-care visits (33 %, 68/208). Only 19 % (39/210) of residents used screening instruments capable of detecting binge drinking. The most frequently reported barrier to SBI was lack of adequate training (54 %, 108/202), and only 21 % (43/208) of residents felt confident they could help at -risk drinkers. When residents did perform a brief intervention, only 24 % (49/208) “usually” or “always” included the three recommended elements.CONCLUSIONSA minority of residents in this multi-site study appropriately screen or intervene with at-risk alcohol users. To equip residents to effectively address hazardous alcohol use, there is a critical need for educational and clinic interventions to support alcohol-related SBI.
Highlights
Binge drinking has been highlighted in the media after the Centers for Disease Control and Prevention (CDC) reported binge drinking rates in adult women and high school girls of 12.5 % and 19.8 %, respectively.[6, 7]
While medical school curricula have traditionally focused on alcohol dependence, the majority of alcoholrelated death and morbidity is due to binge drinking and not chronic misuse.[8]
Half (48 %) were in their PGY1 year of training, 80 % were born in the United States, and 61 % were 30 years old or younger
Summary
One in six adult Americans binge drink and 4– 5 % meet diagnostic criteria for alcohol dependence.[1,2,3,4,5] For young adults aged 18–24 years, rates of binge drinking are even higher and exceed 25 %.1 Recently, binge drinking has been highlighted in the media after the Centers for Disease Control and Prevention (CDC) reported binge drinking rates in adult women and high school girls of 12.5 % and 19.8 %, respectively.[6, 7] While medical school curricula have traditionally focused on alcohol dependence, the majority of alcoholrelated death and morbidity is due to binge drinking (or acute alcohol misuse) and not chronic misuse.[8]. Since 2004, the U.S Preventive Services Task Force (USPSTF) has recommended that all primary care practices incorporate SBI to detect and intervene with binge drinkers, defined as individuals who exceed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommended daily alcohol limits.[3, 21, 22] SBI is often not performed.[9, 13, 14] Despite these recommendations, a recent report from the CDC found that only one in six adults reports discussing alcohol use with their health care provider.[23]. The U.S Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention. OBJECTIVE: We aimed to determine primary care residents’ current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI). MAIN MEASURES: Our survey assessed residents’ alcohol screening practices (instruments used and frequency of screening), perceived barriers to discussing alcohol, brief intervention content, and self-rated ability to help hazardous drinkers.
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