Pugatch Marianne, Chang Grace, Garnick Deborah, Brolin Mary, Brief Deborah, Miller Christopher, Fleming Jerry, Blaney Daryl, Harward Brian, Hodgkin Dominic
Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Boston, MA, USA; VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Subst Abuse Treat. 2021 Apr;123:108257. doi: 10.1016/j.jsat.2020.108257. Epub 2020 Dec 24.
Approximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3-4; =5-7; =8-12), and the role of alcohol risk level and other factors in predicting receipt of BI.
From administrative data (2010-2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not.
While almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems.
Given that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.
在接受退伍军人事务部（VA）医疗服务的女性退伍军人中，约四分之一存在不健康饮酒行为。有充分证据表明，采用性别敏感筛查（AUDIT-C = 3）和简短干预（BI）可降低女性退伍军人不健康饮酒相关风险；然而，VA的政策和激励措施仍保持性别中立（AUDIT-C = 5）。在较低风险饮酒水平筛查呈阳性（AUDIT-C = 3或4）的女性退伍军人可能会被排除在外，从而无法接受简短干预。本研究旨在通过确定不同酒精风险水平（AUDIT-C = 3 - 4；= 5 - 7；= 8 - 12）下的简短干预实施率，以及酒精风险水平和其他因素在预测接受简短干预方面的作用，来研究女性退伍军人简短干预实践实施中的差距。
我们从行政数据（2010 - 2016年）中抽取了近期战争归来且接受门诊和/或住院治疗的女性退伍军人样本。在869名女性退伍军人中，284人在性别敏感切点（AUDIT-C≥3）及以上筛查出不健康饮酒呈阳性。我们采用病历审查方法从病历中提取变量，然后运用逻辑回归比较不同酒精风险水平下接受简短干预的女性退伍军人与未接受者。
虽然近60%的酒精阳性风险样本接受了简短干预，但在较低风险饮酒筛查呈阳性的女性退伍军人子集中（57%；AUDIT-C = 3或4），只有34%接受了简短干预。初级保健项目中的护士比心理健康项目中的其他类型临床医生（如医生、心理学家、社会工作者）提供简短干预的可能性更小；此外，女性健康项目中的护士比混合性别项目中的其他类型临床医生提供简短干预的可能性更小；医疗问题较多的女性退伍军人接受简短干预的可能性并不比医疗问题较少的女性退伍军人更高。
鉴于女性退伍军人是一个快速增长的退伍军人群体且是VA的优先关注对象，对于在较低风险水平筛查呈阳性以及患有更多医疗合并症的女性退伍军人，简短干预利用不足的情况需要引起关注，初级保健和女性健康项目中简短干预服务提供方面的潜在差距也同样如此。针对年轻的高风险或患有共病的女性退伍军人队列进行量身定制的筛查，并对提供者进行简短干预实施最佳实践的培训，可能会改善女性退伍军人的健康和福祉。
