A Randomized Controlled Trial of IVR-Based Alcohol Brief Intervention to Promote Patient–Provider Communication in Primary Care

• Published in: Journal of general internal medicine : JGIM 2016-09, Vol.31 (9), p.996-1003
• Main Authors: Rose, Gail L., Badger, Gary J., Skelly, Joan M., Ferraro, Tonya A., MacLean, Charles D., Helzer, John E.
• Format: Article
• Language: English
• Subjects: Abuse; Adolescent; Adult; Aged; Alcohol abuse; Alcohol Drinking - prevention & control; Alcohol Drinking - psychology; Alcohol use; Alcoholism; Alcoholism - prevention & control; Alcoholism - psychology; Alcohols; Automation; Clinical trials; Colleges & universities; Communication; Drinking; Drinking behavior; Drug abuse; Early Medical Intervention - methods; Education; Female; Health care; Health care facilities; Humans; Interactive systems; Internal Medicine; Intervention; Male; Medicine; Medicine & Public Health; Middle Aged; Original Research; Patients; Physician-Patient Relations; Primary care; Primary Health Care - methods; Randomization; Redesign; Simulation Training - methods; Single-Blind Method; Surveys and Questionnaires; Voice communication; Young Adult
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-016-3692-4

ABSTRACT BACKGROUND Brief interventions for unhealthy drinking in primary care settings are efficacious, but underutilized. Efforts to improve rates of brief intervention though provider education and office systems redesign have had limited impact. Our novel brief intervention uses interactive voice response (IVR) to provide information and advice directly to unhealthy drinkers before a physician office visit, with the goals of stimulating in-office dialogue about drinking and decreasing unhealthy drinking. This automated approach is potentially scalable for wide application. OBJECTIVE We aimed to examine the effect of a pre-visit IVR-delivered brief alcohol intervention (IVR-BI) on patient–provider discussions of alcohol during the visit. DESIGN This was a parallel group randomized controlled trial with two treatment arms: 1) IVR-BI or 2) usual care (no IVR-BI). PARTICIPANTS In all, 1,567 patients were recruited from eight university medical center-affiliated internal medicine and family medicine clinics. INTERVENTIONS IVR-BI is a brief alcohol intervention delivered by automated telephone. It has four components, based on the intervention steps outlined in the National Institute of Alcohol Abuse and Alcoholism guidelines for clinicians: 1) ask about alcohol use, 2) assess for alcohol use disorders, 3) advise patient to cut down or quit drinking, and 4) follow up at subsequent visits. MAIN MEASURES Outcomes were patient reported: patient–provider discussion of alcohol during the visit; patient initiation of the discussion; and provider’s recommendation about the patient’s alcohol use. KEY RESULTS Patients randomized to IVR-BI were more likely to have reported discussing alcohol with their provider (52 % vs. 44 %, p  = 0.003), bringing up the topic themselves (20 % vs. 12 %, p