Wooten Nikki R, Tavakoli Abbas S, Al-Barwani Marlene B, Thomas Naomi A, Chakraborty Hrishikesh, Scheyett Anna M, Kaminski Kelly M, Woods Alyssia C, Levkoff Sue E
a College of Social Work , University of South Carolina , Columbia , SC , USA.
b Lieutenant Colonel, U. S. Army Reserves , Columbia , SC , USA.
Am J Drug Alcohol Abuse. 2017 Sep;43(5):545-555. doi: 10.1080/00952990.2017.1286499. Epub 2017 Apr 14.
Screening older veterans in Veterans Affairs Medical Center (VAMC) primary care clinics for risky drinking facilitates early identification and referral to treatment.
This study compared two behavioral health models, integrated care (a standardized brief alcohol intervention co-located in primary care clinics) and enhanced referral care (referral to specialty mental health or substance abuse clinics), for reducing risky drinking among older male VAMC primary care patients. VAMC variation was also examined.
A secondary analysis of longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study, a multisite randomized controlled trial, was conducted with a sample of older male veterans (n = 438) who screened positive for risky drinking and were randomly assigned to integrated or enhanced referral care at five VAMCs.
Generalized estimating equations revealed no differences in either behavioral health model for reducing risky drinking at a 6-month follow-up (AOR: 1.46; 95% CI: 0.42-5.07). Older veterans seen at a VAMC providing geriatric primary care and geriatric evaluation and management teams had lower odds of risky drinking (AOR: 0.24; 95% CI: 0.07-0.81) than those seen at a VAMC without geriatric primary care services.
Both integrated and enhanced referral care reduced risky drinking among older male veterans. However, VAMCs providing integrated behavioral health and geriatric specialty care may be more effective in reducing risky drinking than those without these services. Integrating behavioral health into geriatric primary care may be an effective public health approach for reducing risky drinking among older veterans.
在退伍军人事务医疗中心（VAMC）的初级保健诊所对老年退伍军人进行危险饮酒筛查，有助于早期识别并转诊接受治疗。
本研究比较了两种行为健康模式，即综合护理（在初级保健诊所同时开展标准化简短酒精干预）和强化转诊护理（转诊至精神健康或药物滥用专科诊所），以减少老年男性VAMC初级保健患者中的危险饮酒情况。同时还研究了VAMC之间的差异。
对老年男性退伍军人（n = 438）样本进行了一项二次分析，这些退伍军人来自多中心随机对照试验“老年人药物滥用和精神健康初级保健研究（PRISM-E）”的纵向数据，他们的危险饮酒筛查呈阳性，并被随机分配到五个VAMC接受综合护理或强化转诊护理。
广义估计方程显示，在6个月的随访中，两种行为健康模式在减少危险饮酒方面没有差异（比值比：1.46；95%置信区间：0.42 - 5.07）。在提供老年初级保健以及老年评估和管理团队的VAMC接受治疗的老年退伍军人，与在没有老年初级保健服务的VAMC接受治疗的退伍军人相比，危险饮酒的几率更低（比值比：0.24；95%置信区间：0.07 - 0.81）。
综合护理和强化转诊护理均降低了老年男性退伍军人中的危险饮酒情况。然而，提供综合行为健康和老年专科护理的VAMC在减少危险饮酒方面可能比没有这些服务的VAMC更有效。将行为健康纳入老年初级保健可能是减少老年退伍军人危险饮酒的一种有效公共卫生方法。
