The Association between Receipt of Brief Alcohol Intervention and Quality of Care among Veteran Outpatients with Unhealthy Alcohol Use

Abstract

Background: Brief alcohol intervention, including advice to reduce or abstain from drinking, is widely recommended for general medical outpatients with unhealthy alcohol use. Providers report reluctance to deliver such interventions citing concerns about negatively affecting their patient relationships Objective: To determine, among veteran outpatients with unhealthy use, whether receipt of brief intervention was associated with patient-reported indicators of care quality. Design: Cross-sectional, secondary analysis of quality improvement data collected through the VA Survey of Healthcare Experiences of Patients (SHEP). Patients: Veteran outpatients who: 1) responded to the outpatient, long-form SHEP (2009-2011), 2) screened positive for unhealthy alcohol use (Alcohol Use Disorder Identification Test Consumption Questionnaire [AUDIT-C] score ≥3 women; ≥4 men), and 3) responded to a question regarding receipt of brief intervention and to two questions assessing patient ratings of care quality. Main Measures: We used generalized estimating equations to determine the independent associations between receipt of brief intervention (patient-reported receipt of alcohol-related advice from a VA provider in the preceding year) and two quality of care ratings: patient-reported ratings of their VA provider and overall VA health care (range 0-10, dichotomized ≥9 to indicate high quality). Key Results: Among 10,612 veterans meeting inclusion criteria (16.0% of all respondents), 43.7% reported receipt of brief intervention, and 84.2% and 79.1% of respondents rated their provider and VA health care as high quality, respectively. In multivariable models, compared to veterans who did not report brief intervention, those who reported brief intervention were more likely to rate their provider (86.9% vs. 82.0%, p<0.01) and overall VA healthcare (82.7% vs. 75.9%, p<0.01) as high quality. Conclusions: Results from this cross-sectional analysis among veterans with unhealthy alcohol use demonstrate that receipt of brief intervention was positively associated with patient-reported indicators of high quality care, findings that are in opposition to provider concerns that delivering such advice may adversely affect patients' perceptions of their care.