Alcohol Drinking as a Vital Sign (ADVISE)

Kaiser Permanente

Status: Completed

Conditions: Alcohol Dependence; Unhealthy Drinking

Treatments: Other: Training & Tech Support for Delivery of Alcohol Screening, Brief Intervention, and Referral To Treatment

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01135654

CN-09JMert-03-H

R01AA018660 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of this study is to determine whether Alcohol Screening, Brief Intervention, and Referral to Specialty Chemical Dependency Treatment (as appropriate) by Non-Physicians versus Primary Care Providers (versus control group) is more likely to be implemented and more effective at reducing unsafe drinking.

Full description

This health services implementation study is a clustered, randomized trial. We propose to randomize primary care clinics to three arms-a control condition and two alternative modes of delivery of the NIAAA Clinician's Guide to Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care settings. In the Primary Care Physician or "PCP" arm, PCPs will be trained on the SBIRT protocols outlined in the NIAAA Clinicians' Guide and conduct brief intervention and referrals as needed. In the Non-Physician Provider or "NPP" arm, Medical Assistants will be trained to use the NIAAA screener and enter the results in the Electronic Medical Record, and NPPs (e.g., Behavioral Medicine Specialists, Clinical Nurses and Health Educators) will conduct brief intervention and referral activities. The SBIRT content, based on the NIAAA Guide, is the same in both the NPP and PCP arms; we compare delivery by the two types of providers and versus the control condition, in which providers and staff will not receive any training on SBIRT protocols. We examine implementation outcomes: rates of screening, brief intervention, follow-up screening and brief intervention, referral to Chemical Dependency treatment, and alcohol use disorders medication rates. We also include, as secondary analyses, an effectiveness study examining patient outcomes by study arm.

Enrollment: 639,613 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients: All patients aged 18+ who receive primary care visits in the Kaiser Permanente clinics in Northern California.

Exclusion criteria

• Patients younger than 18.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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639,613 participants in 3 patient groups

Non-Physician Provider

Experimental group

Treatment:

Other: Training & Tech Support for Delivery of Alcohol Screening, Brief Intervention, and Referral To Treatment

Control

No Intervention group

Primary Care Provider

Active Comparator group

Description:

In clinics randomized to this arm, we will train (and provide technical assistance to) Primary Care providers to conduct Alcohol Screening, Brief Intervention, and Referral to Treatment.

Treatment:

Other: Training & Tech Support for Delivery of Alcohol Screening, Brief Intervention, and Referral To Treatment