Unhealthy Alcohol Use in Primary Care-The Elephant in the Examination Room.

Published on Jan 1, 2019in JAMA Internal Medicine18.652
· DOI :10.1001/JAMAINTERNMED.2018.6125
E. Jennifer Edelman23
Estimated H-index: 23
(Yale University),
Jeanette M. Tetrault23
Estimated H-index: 23
(Yale University)
Sources
Abstract
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201845.54JAMA
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References16
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#2Kailyn E. Young (NYU: New York University)H-Index: 3
Last. Scott Braithwaite (NYU: New York University)H-Index: 6
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Importance: Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. Objective: To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. Design, Setting, and Participants: This longitudinal cohort study used da...
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#1US Preventive Services Task Force (UI: University of Iowa)H-Index: 23
#2Susan J. Curry (UI: University of Iowa)H-Index: 89
Last. John B. Wong (Tufts University)H-Index: 95
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Importance Excessive alcohol use is one of the most common causes of premature mortality in the United States. From 2006 to 2010, an estimated 88 000 alcohol-attributable deaths occurred annually in the United States, caused by both acute conditions (eg, injuries from motor vehicle collisions) and chronic conditions (eg, alcoholic liver disease). Alcohol use during pregnancy is also one of the major preventable causes of birth defects and developmental disabilities. Objective To update the US Pr...
95 CitationsSource
#1Elizabeth O'Connor (KP: Kaiser Permanente)H-Index: 44
#2Leslie A Perdue (KP: Kaiser Permanente)H-Index: 17
Last. Daniel E Jonas (UNC: University of North Carolina at Chapel Hill)H-Index: 4
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Importance Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. Objective To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. Data Sources MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018. Study Selection Test accuracy studies and randomized clinical tria...
51 CitationsSource
#1Max Griswold (UW: University of Washington)H-Index: 14
#2Nancy Fullman (UW: University of Washington)H-Index: 58
Last. Emmanuela GakidouH-Index: 61
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Summary Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations fr...
759 CitationsSource
#1Emily C. Williams (UW: University of Washington)H-Index: 1
#1Emily C. Williams (KP: Kaiser Permanente)H-Index: 1
Last. Katharine A. Bradley (UW: University of Washington)H-Index: 35
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Abstract Background Alcohol use has important adverse effects on people living with HIV (PLWH). This study of patients with recognized unhealthy alcohol use estimated and compared rates of alcohol-related care received by PLWH and HIV- patients. Methods Outpatients from the Veterans Health Administration who had one or more positive screen(s) for unhealthy alcohol use (AUDIT-C ≥ 5) documented in their medical records 10/2009-5/2013 were eligible. Primary and secondary outcomes were brief interve...
32 CitationsSource
This issue provides a clinical overview of alcohol use, focusing on health benefits, harms, prevention, screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions an...
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#1Yiqun Chen (Duke University)H-Index: 21
#1Yiqun Chen (Duke University)H-Index: 4
Last. Arseniy P. Yashkin (Duke University)H-Index: 12
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Abstract Aims Analyze relationships between adherence to guidelines for diabetes care – regular screening; physical activity; and medication – and diabetes complications and mortality. Methods Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65 + in the Health and Retirement Study (HRS) 2003 Diabe...
30 CitationsSource
#1Emily C. Williams (UW: University of Washington)H-Index: 32
#1Emily C. Williams (UW: University of Washington)H-Index: 17
Last. Katharine A. Bradley (Group Health Research Institute)H-Index: 28
view all 9 authors...
BACKGROUND Population-based alcohol screening is recommended in primary care, and increasingly incentivized by policies, yet is challenging to implement. The U.S. Veterans Health Administration (VA) achieved high rates of screening using a national performance measure and associated electronic clinical reminder to prompt and facilitate screening and document results. However, the sensitivity of alcohol screening for identifying unhealthy alcohol use is low in VA clinics.
54 CitationsSource
#1John F. Kelly (Harvard University)H-Index: 53
#1John Kelly (Harvard University)H-Index: 103
Last. Richard Saitz (BMC: Boston Medical Center)H-Index: 66
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53 CitationsSource
#1Susan A. Stoner (UW: University of Washington)H-Index: 28
#2A. Tasha MikkoH-Index: 2
Last. Kelly M. CarpenterH-Index: 2
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Abstract This project evaluated a Web-based multimedia training for primary care providers in screening, brief intervention, and referral to treatment (SBIRT) for unhealthy use of alcohol, tobacco, and other drugs. Physicians (n=37), physician assistants (n=35), and nurse practitioners (n=20) were recruited nationally by email and randomly assigned to online access to either the multimedia training or comparable reading materials. At baseline, compared to non-physicians, physicians reported lowe...
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Cited By6
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#1Benjamin J. Oldfield (Yale University)H-Index: 7
#2E. Jennifer Edelman (Yale University)H-Index: 23
Individuals with unhealthy alcohol use are at increased risk for HIV acquisition and may benefit from receiving HIV pre-exposure prophylaxis (PrEP) in primary care settings. To date, literature synthesizing what is known about the impact of unhealthy alcohol use on the PrEP care continuum with a focus on considerations for primary care is lacking. We searched OVID Medline and Web of Science from inception through March 19, 2020, to examine the extent, range, and nature of research on PrEP delive...
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#1Tibor P. Palfai (BU: Boston University)H-Index: 38
#2Maya P. L. Kratzer (BU: Boston University)H-Index: 2
Last. Judith Bernstein (BU: Boston University)H-Index: 28
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BACKGROUND Chronic pain and heavy drinking are conditions that commonly co-occur among primary care patients. Despite the availability of behavioral interventions that target these conditions individually, engagement and adherence to treatment remain a challenge, and there have been no interventions designed to address both of these conditions together for patients presenting to primary care. This study seeks to incorporate the perspectives of patients regarding symptoms, treatment experiences, ...
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#1Veronica Richards (UF: University of Florida)H-Index: 1
Last. Robert L. Cook (UF: University of Florida)H-Index: 55
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Background Understanding how perceived positive consequences are associated with drinking may help improve effectiveness of alcohol reduction interventions among people living with HIV (PLWH). We aimed to determine whether perceived positive consequence scores varied by sociodemographic, drinking, mental health or substance use variables. Methods Perceived positive consequences of drinking were assessed using the PROMIS: Positive Consequences-Short Form. Unhealthy alcohol use was measured using ...
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#1E. Jennifer Edelman (Yale University)H-Index: 23
#2Stephen A. Maisto (SU: Syracuse University)H-Index: 80
Last. David A. Fiellin (Yale University)H-Index: 75
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At-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol use. In this multi-site, randomized trial conducted between January 28, 2013 through July 14, 2017, we enrolled PWH and at-risk alcohol use [defined as alcohol cons...
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#1Madeline C. Frost (UW: University of Washington)H-Index: 4
#1Madeline C. Frost (Veterans Health Administration)H-Index: 3
Last. Emily C. Williams (UW: University of Washington)H-Index: 3
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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: US Veterans Health Admini...
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#1Maria R. Khan (NYU: New York University)H-Index: 19
#2Kailyn E. Young (NYU: New York University)H-Index: 3
Last. Scott Braithwaite (NYU: New York University)H-Index: 6
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Importance: Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. Objective: To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. Design, Setting, and Participants: This longitudinal cohort study used da...
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