Department of Psychiatry, University of Pittsburgh, PA, USA.
Department of Health Systems and Population Health, University of Washington, School of Public Health, Seattle, WA, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
J Subst Use Addict Treat. 2023 Sep;152:209117. doi: 10.1016/j.josat.2023.209117. Epub 2023 Jun 23.
Brief intervention (BI) is recommended for all primary care (PC) patients who screen positive for unhealthy alcohol use; however, patients with multiple chronic health conditions who are at high-risk of hospitalization (i.e., "high complexity" patients) may face disparities in receiving BIs in PC. The current study investigated whether high complexity and low complexity patients in the Veterans Health Administration (VHA) differed regarding screening positive for unhealthy alcohol use, alcohol-use severity, and receipt of BI for those with unhealthy alcohol use.
Patients were veterans receiving PC services at the VHA in a mid-Atlantic region of the United States. The study extracted VHA administrative and clinical data for a total of 282,242 patients who had ≥1 PC visits between 1/1/2014 and 12/31/2014, during which they were screened for unhealthy alcohol use by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). The study defined high complexity patients as those within and above the 90th percentile of risk for hospitalization per the VHA's Care Assessment Need Score. Logistic regression models assessed if being a high complexity patient was associated with screening positive for unhealthy alcohol use (AUDIT-C ≥ 5), severity of unhealthy alcohol use in those who screened positive (AUDIT-C score range 5-12), and receipt of BI in those who screened positive.
Our sample was 94.5% male, 83% White, 13% Black, 4% other race, and 1.7% Hispanic. A total of 10,813 (3.8%) patients screened positive for unhealthy alcohol use from which we identified 569 (5.3%) high complexity and 10,128 (93.6%) low complexity patients (n = 116 removed due to missing complexity data). Relative to low complexity patients, high complexity patients were less likely to screen positive for unhealthy alcohol use (3.3% vs. 4.1%, AOR = 0.59, p < .001); however, in patients who screened positive, high complexity patients had higher AUDIT-C scores (Mean AUDIT-C = 7.75 vs. 6.87, AOR = 1.46, p < .001) and were less likely to receive a BI (78.0% vs. 92.6%, AOR = 0.42, p < .001).
Disparities in BI exist for highly complex patients despite having more severe unhealthy alcohol use. Future research should examine the specific patient- and/or clinic-level factors impeding BI delivery for complex patients.
简短干预（BI）建议用于所有对不健康饮酒进行筛查呈阳性的初级保健（PC）患者；然而，患有多种慢性健康状况且住院风险高（即“高复杂性”患者）的患者在接受 PC 中的 BI 方面可能存在差异。本研究调查了退伍军人健康管理局（VHA）中的高复杂性和低复杂性患者在对不健康饮酒进行筛查呈阳性、饮酒严重程度以及对有不健康饮酒行为的患者进行 BI 方面是否存在差异。
患者为在美国大西洋中部地区接受 VHA PC 服务的退伍军人。该研究从退伍军人健康管理局的行政和临床数据中提取了 282242 名患者的数据，这些患者在 2014 年 1 月 1 日至 2014 年 12 月 31 日期间至少进行了 1 次 PC 就诊，在此期间，他们通过酒精使用障碍识别测试-消耗（AUDIT-C）筛查了不健康的饮酒情况。该研究将高复杂性患者定义为退伍军人健康管理局的护理评估需求评分中住院风险的第 90 百分位及以上的患者。逻辑回归模型评估了成为高复杂性患者是否与不健康饮酒筛查呈阳性（AUDIT-C≥5）、筛查呈阳性患者的不健康饮酒严重程度（AUDIT-C 评分范围 5-12）以及筛查呈阳性患者接受 BI 治疗相关。
我们的样本中 94.5%为男性，83%为白人，13%为黑人，4%为其他种族，1.7%为西班牙裔。共有 10813 名（3.8%）患者筛查出不健康饮酒，其中我们确定了 569 名（5.3%）高复杂性和 10128 名（93.6%）低复杂性患者（由于复杂性数据缺失，共 116 名被排除）。与低复杂性患者相比，高复杂性患者筛查出不健康饮酒的可能性较低（3.3%比 4.1%，优势比[OR]为 0.59，p<0.001）；然而，在筛查呈阳性的患者中，高复杂性患者的 AUDIT-C 评分更高（平均 AUDIT-C 为 7.75 比 6.87，OR 为 1.46，p<0.001），接受 BI 的可能性较低（78.0%比 92.6%，OR 为 0.42，p<0.001）。
尽管高复杂性患者的不健康饮酒情况更为严重，但他们在 BI 方面仍存在差异。未来的研究应研究阻碍复杂患者接受 BI 治疗的特定患者和/或临床层面的因素。
