Bertholet Nicolas, Horton Nicholas J, Saitz Richard
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
BMC Public Health. 2009 Apr 9;9:101. doi: 10.1186/1471-2458-9-101.
The course of alcohol consumption and cognitive dimensions of behavior change (readiness to change, importance of changing and confidence in ability to change) in primary care patients are not well described. The objective of the study was to determine changes in readiness, importance and confidence after a primary care visit, and 6-month improvements in both drinking and cognitive dimensions of behavior change, in patients with unhealthy alcohol use.
Prospective cohort study of patients with unhealthy alcohol use visiting primary care physicians, with repeated assessments of readiness, importance, and confidence (visual analogue scale (VAS), score range 1-10 points). Improvements 6 months later were defined as no unhealthy alcohol use or any increase in readiness, importance, or confidence. Regression models accounted for clustering by physician and adjusted for demographics, alcohol consumption and related problems, and discussion with the physician about alcohol.
From before to immediately after the primary care physician visit, patients (n = 173) had increases in readiness (mean +1.0 point), importance (+0.2), and confidence (+0.5) (all p < 0.002). In adjusted models, discussion with the physician about alcohol was associated with increased readiness (+0.8, p = 0.04). At 6 months, many participants had improvements in drinking or readiness (62%), drinking or importance (58%), or drinking or confidence (56%).
Readiness, importance and confidence improve in many patients with unhealthy alcohol use immediately after a primary care visit. Six months after a visit, most patients have improvements in either drinking or these cognitive dimensions of behavior change.
初级保健患者的饮酒过程以及行为改变的认知维度（改变的意愿、改变的重要性和改变能力的信心）尚未得到充分描述。本研究的目的是确定初级保健就诊后改变意愿、重要性和信心的变化，以及不健康饮酒患者在饮酒和行为改变的认知维度方面6个月后的改善情况。
对就诊于初级保健医生的不健康饮酒患者进行前瞻性队列研究，对改变意愿、重要性和信心进行重复评估（视觉模拟量表（VAS），评分范围1 - 10分）。6个月后的改善定义为无不健康饮酒或改变意愿、重要性或信心有任何增加。回归模型考虑了医生的聚类情况，并对人口统计学、饮酒量及相关问题，以及与医生关于饮酒的讨论进行了调整。
从初级保健医生就诊前到就诊后即刻，患者（n = 173）的改变意愿（平均增加1.0分）、重要性（增加0.2分）和信心（增加0.5分）均有所提高（所有p < 0.002）。在调整模型中，与医生关于饮酒的讨论与改变意愿增加有关（增加0.8分，p = 0.04）。在6个月时，许多参与者在饮酒或改变意愿（62%）、饮酒或重要性（58%）或饮酒或信心（56%）方面有改善。
许多不健康饮酒患者在初级保健就诊后即刻，改变意愿、重要性和信心有所提高。就诊6个月后，大多数患者在饮酒或这些行为改变的认知维度方面有改善。
