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Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders
Addiction ( IF 6 ) Pub Date : 2019-12-11 , DOI: 10.1111/add.14836
Madeline C Frost 1, 2 , Joseph E Glass 3 , Katharine A Bradley 1, 2, 3, 4 , Emily C Williams 1, 2
Affiliation  

BACKGROUND AND AIMS Alcohol screening, brief intervention (BI), and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING U.S. Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥5) (n=830,825) documented nationally 10/01/09-5/30/13. MEASUREMENTS Regression models estimated prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared with those without. Models, clustered on patient and adjusted for demographics and mental health and substance use conditions, were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment (adjusted incidence rate ratio [aIRR] 0.84, 95% confidence interval 0.83-0.84). Associations were similar for those with and without AUD (aIRR 0.83, 0.82-0.84 and 0.86, 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of >1 BI was associated with greater likelihood of treatment relative to no BI (aIRR 1.75, 1.68-1.83). CONCLUSIONS In a national sample of U.S. Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.

中文翻译:

在 VA 患者的全国样本中,有或没有酒精使用障碍的不健康酒精使用与减少与专业成瘾治疗的联系相关的记录的简短干预

背景和目的 酒精筛查、短暂干预 (BI) 和转诊治疗通常被认为是阶梯式护理,因此转诊的 BI 将患者与治疗联系起来。一项随机试验的荟萃分析发现,没有证据表明 BI 会增加酒精使用障碍 (AUD) 的治疗。本研究旨在确定 BI 是否与接受 BI 作为常规护理一部分的患者接受 AUD 治疗相关。设计回归分析。设置美国退伍军人健康管理局 (VA),其中 BI 由性能测量和电子临床提醒支持。参与者 10/01/09-5/30/13 在全国记录的酒精使用障碍鉴定测试阳性的 VA 门诊患者 (≥5) (n=830,825)。测量 回归模型估计了与没有记录的 BI(在 0-14 天内减少/戒烟的建议)的患者相比,在 0-365 天内接受 VA 专业成瘾治疗的患病率。模型集中在患者身上,并根据人口统计学、心理健康和物质使用条件进行了调整,适用于所有患者,并在记录的过去一年 AUD 诊断中分层。多项二级分析评估了结果的稳健性,包括评估重复的 BI 作为预测因素。在 830,825 名不健康饮酒的 VA 门诊患者(1,172,606 例阳性筛查)中,记录的 BI 与接受 VA 专业成瘾治疗的可能性较低相关(调整后的发病率比 [aIRR] 0.84,95% 置信区间 0.83-0.84)。有和没有 AUD 的人的相关性相似(aIRR 分别为 0.83、0.82-0.84 和 0.86、0.83-0.88),并且在大多数次要分析中。然而,在没有 AUD 的患者中,与没有 BI 相比,>1 BI 的记录与更大的治疗可能性相关(aIRR 1.75、1.68-1.83)。结论 在美国退伍军人健康管理局不健康饮酒患者的全国样本中,无论酒精使用障碍诊断如何,记录在案的短暂饮酒干预与接受专业成瘾治疗的可能性较低有关。
更新日期:2019-12-11
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