Vinson D C, Elder N, Werner J J, Vorel L A, Nutting P A
University of Missouri-Columbia, Family Medicine, 65212, USA.
J Fam Pract. 2000 Jan;49(1):28-33.
Problem drinking is common, and a 15-minute intervention can help some patients reduce drinking to safe levels. Little is known, however, about the frequency and duration of alcohol-related discussions in primary care.
Nineteen clinicians in the Ambulatory Sentinel Practice Network (ASPN) collected data about alcohol-related discussions for 1 week following their usual office routine (Phase 1) and for 1 week with the addition of routine screening for problem drinking (Phase 2). Of those, 15 clinicians collected data for a third week after receiving training in brief interventions with problem drinkers (Phase 3). Clinicians collected data on standard ASPN reporting cards.
In Phase 1 the clinicians discussed alcohol during 9.6% of all visits. Seventy-three percent of those discussions were shorter than 2 minutes long, and only 10% lasted longer than 4 minutes. When routine screening was added (Phase 2), clinicians were more likely to discuss alcohol at acute-illness visits, but the frequency, duration, and intensity of such discussions did not change. Only 32% of Phase 2 discussions prompted by a positive screening result lasted longer than 2 minutes. After training, the duration increased (P <.004). In Phase 3, 58% of discussions prompted by a positive screening result lasted longer than 2 minutes, but only 26% lasted longer than 4 minutes.
Routine screening changed the kinds of visits during which clinicians discussed alcohol use. Training in brief-intervention techniques significantly increased the duration of alcohol-related discussions, but most discussions prompted by a positive screening result were still shorter than effective interventions reported in the literature.
问题饮酒很常见，15分钟的干预措施可帮助一些患者将饮酒量降至安全水平。然而，对于初级保健中与酒精相关讨论的频率和时长，我们知之甚少。
门诊哨点实践网络（ASPN）的19名临床医生按照日常办公流程收集了1周内与酒精相关讨论的数据（第1阶段），并在增加对问题饮酒进行常规筛查的情况下收集了1周的数据（第2阶段）。其中，15名临床医生在接受针对问题饮酒者的简短干预培训后，又收集了第3周的数据（第3阶段）。临床医生在标准的ASPN报告卡上记录数据。
在第1阶段，临床医生在所有就诊中9.6%的时间里讨论了酒精问题。这些讨论中73%持续时间不到2分钟，只有10%持续时间超过4分钟。增加常规筛查后（第2阶段），临床医生更有可能在急性病就诊时讨论酒精问题，但此类讨论的频率、时长和强度并未改变。筛查结果呈阳性引发的第2阶段讨论中，只有32%持续时间超过2分钟。培训后，讨论时长有所增加（P<.004）。在第3阶段，筛查结果呈阳性引发的讨论中，58%持续时间超过2分钟，但只有26%持续时间超过4分钟。
常规筛查改变了临床医生讨论饮酒问题的就诊类型。简短干预技术培训显著增加了与酒精相关讨论的时长，但筛查结果呈阳性引发的大多数讨论仍短于文献中报道的有效干预时长。
