Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE CHOICE trialReportar como inadecuado

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE CHOICE trial - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Addiction Science and Clinical Practice

, 12:15

First Online: 17 May 2017Received: 12 October 2016Accepted: 28 April 2017DOI: 10.1186-s13722-017-0080-2

Cite this article as: Bradley, K.A., Ludman, E.J., Chavez, L.J. et al. Addict Sci Clin Pract 2017 12: 15. doi:10.1186-s13722-017-0080-2


BackgroundMost patients with alcohol use disorders AUDs never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE CHOICE trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication TIDieR, results of recruitment, and baseline characteristics of the enrolled sample.

MethodsThe CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking ≥4 drinks-day for women; ≥5 for men were recruited 2011–2014 into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and-or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.

ResultsA total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 range 22–75, and most met DSM-IV criteria for alcohol abuse 14% or dependence 59%. Many participants also screened positive for tobacco use 44%, depression 45%, anxiety disorders 30-41% and non-tobacco drug use disorders 19%. At baseline, participants had a median AUDIT score of 18 Interquartile range IQR 14–24 and a median readiness to change drinking score of 5 IQR 2.75–6.25 on a 1–10 Likert scale.

ConclusionThe CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking.

Trial registration The trial is registered at NCT01400581.

KeywordsShared decision making Alcohol use disorder Care management Brief interventions Chronic Care Model Patient-centered care Medical management Veterans Primary care Intervention AbbreviationsAAAlcoholics Anonymous

AUDalcohol use disorder

AUDITAlcohol Use Disorder Identification Test

CDTcarbohydrate-deficient transferring

CHOICEChoosing Healthier Drinking Options in primary CarE study

COMBINEThe Combined Pharmacotherapies and Behavioral Interventions study

DSMDiagnostic and Statistical Manual of Mental Disorders

DUDnon-alcohol, non-tobacco drug use disorders

EHRelectronic health record

FDAFood and Drug Administration

GAD-77-Item Generalized Anxiety Disorder screen

GGTgamma glutamyl transferase

MCVmean corpuscular volume

MImotivational interviewing

MINIMini International Neuropsychiatric Interview

NIAAANational Institute on Alcohol Abuse and Alcoholism

PHQ-99-item Patient Health Questionnaire

PTSDPost-traumatic stress disorder

SF-1212-item Short Form

SIPShort Inventory of Problems

TLFBtime-line follow-back

VAVeterans Affairs

Electronic supplementary materialThe online version of this article doi:10.1186-s13722-017-0080-2 contains supplementary material, which is available to authorized users.

Autor: Katharine A. Bradley - Evette Joy Ludman - Laura J. Chavez - Jennifer F. Bobb - Susan J. Ruedebusch - Carol E. Achtmey


Documentos relacionados