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Cited by 127Substance Abuse Treatment and OutcomesHealth Policy Implementation ScienceAlcohol Consumption and Health Effects

Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial

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Mertens, Jennifer R., Chi, Felicia W., Weisner, Constance M., Satre, Derek D., Ross, Thekla B., Allen, Steve, Pating, David, Campbell, Cynthia I. +2 more·2015·Addiction Science & Clinical Practice
DOI 10.1186/s13722-015-0047-0PMC PMC4653951
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Abstract

BACKGROUND: Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended alcohol screening and intervention in general medical settings since 2004. Yet less than one in six US adults report health care professionals discussing alcohol with them. Little is known about methods for increasing implementation; different staffing models may be related to implementation effectiveness. This implementation trial compared delivery of alcohol screening, brief intervention and referral to specialty treatment (SBIRT) by physicians versus non-physician providers receiving training, technical assistance, and feedback reports. METHODS: The study was a cluster randomized implementation trial (ADVISe [Alcohol Drinking as a Vital Sign]). Within a private, integrated health care system, 54 adult primary care clinics were stratified by medical center and randomly assigned in blocked groups of three to SBIRT by physicians (PCP arm) versus non-physician providers and medical assistants (NPP and MA arm), versus usual care (Control arm). NIH-recommended screening questions were added to the electronic health record (EHR) to facilitate SBIRT. We examined screening and brief intervention and referral rates by arm. We also examined patient-, physician-, and system-level factors affecting screening rates and, among those who screened positive, rates of brief intervention and referral to treatment. RESULTS: Screening rates were highest in the NPP and MA arm (51 %); followed by the PCP arm (9 %) and the Control arm (3.5 %). Screening increased over the 12 months after training in the NPP and MA arm but remained stable in the PCP arm. The PCP arm had higher brief intervention and referral rates (44 %) among patients screening positive than either the NPP and MA arm (3.4 %) or the Control arm (2.7 %). Higher ratio of MAs to physicians was related to higher screening rates in the NPP and MA arm and longer appointment times to screening and intervention rates in the PCP arm. CONCLUSION: Findings suggest that time frames longer than 12 months may be required for full SBIRT implementation. Screening by MAs with intervention and referral by physicians as needed can be a feasible model for increasing the implementation of this critical and under-utilized preventive health service within currently predominant primary care models. TRIAL REGISTRATION: Clinical Trials NCT01135654.

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Authors
Mertens, J. R., Chi, F. W., Weisner, C. M., Satre, D. D., Ross, T. B., Allen, S., Pating, D., Campbell, C. I., Lu, Y. W., & Sterling, S. A.
Affiliations
Kaiser Permanente (US)
Corresponding author
Mertens, Jennifer R.
ORCID
Venue
Addiction Science & Clinical Practice
Publisher
Springer Science and Business Media LLC
Published
2015-11-19
Volume
10
Issue
1
Pages
26-26
ISSN
  • 1940-0632 (ISSN-L)
  • 1940-0640
DOI
10.1186/s13722-015-0047-0
PMC
PMC4653951
OpenAlex
W2176590382
Cited by
127
References
94
Citations by year
2026: 6 · 2025: 14 · 2024: 14 · 2023: 13 · 2022: 10 · 2021: 12 · 2020: 12 · 2019: 11 · 2018: 12 · 2017: 14 · 2016: 7 · 2015: 1
FWCI
8.89
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Addiction Science & Clinical Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Strong
  • National Institute on Alcohol Abuse and Alcoholism (R01AA018660)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
alcohol screening, brief intervention, referral to treatment, SBIRT, non-physician providers, medical assistants, primary care, alcohol consumption, integrated health system
MeSH terms
Adolescent, Adult, Age Factors, Alcoholism, Female, Health Personnel, Humans, Inservice Training, Leadership, Male, Mass Screening, Middle Aged, Physicians, Primary Health Care, Referral and Consultation, Sex Factors, Young Adult, Electronic Health Records

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