Our objective is to evaluate the clinical efficacy of alcohol screening and brief intervention (SBI) administered using a telephone-based Interactive Voice Response (IVR) system. Our IVR-based screening tool (IVR-Screen) is programmed to identify patients visiting primary care clinics who meet NIAAA screening criteria for at-risk drinking. The IVR brief intervention (IVR-BI) is modeled after the NIAAA """"""""Clinician's Guide to Helping Patients Who Drink Too Much,"""""""" 2005 updated edition. The efficacy of provider-delivered SBI is clear. However, given the considerable evidence that SBI is rarely done in real-world settings there have been many calls for alternative approaches, including automation. In this application we review the extensive literature documenting significant underutilization of SBI in primary care (PC) settings and the disappointing results of efforts to improve utilization through education, modification of office systems, and/or physician incentives. In Preliminary Studies we present data from our recent pilot study of IVR-based SBI in a representative PC clinic. This pilot confirmed the feasibility of employing an IVR for both screening and brief intervention in a standard PC practice, and its acceptability to patients, providers, and staff. The IVR-Screen identified at-risk drinkers, then those who screened positive were offered the opportunity to access the IVR-BI. Over 70% of them consented to do so. Most (80%) participants said the IVR-BI made them more aware of how much they were drinking, and 40% said it motivated them to make a change in their drinking. In addition, we observed a short-term decline in consumption among those who completed the IVR-BI (n=30).
Our aims now are to conduct a large RCT to: 1) fully test short- and long-term efficacy of the IVR-BI against a usual-care control group;2) determine if IVR-BI prior to a PC visit increases the likelihood of a subsequent provider-delivered BI (PCP-BI);and 3) characterize those patients who do and do not realize a therapeutic benefit from IVR-BI. Patients registered for PC visits at collaborating clinics will be invited to participate at the time of the appointment reminder call 1-2 days prior to the visit. Consenting subjects will take the IVR-Screen, which will determine eligibility for randomization to IVR-BI or usual care. Patients randomized to the treatment group will be asked to access the IVR-BI before their PC visit. Control group participants will receive the usual standard of care but no IVR-BI. Follow-up telephone interviews 48 hours, 3 months and 6 months following the PC visit will assess user acceptability of the IVR-Screen and -BI, ascertain whether a PCP-BI was done, and will document alcohol consumption, alcohol symptoms and related behaviors, and alcohol use disorders. If proven efficacious, screening and brief intervention using an IVR system could be an efficient, low-cost adjunct to primary care practice. Furthermore, since translation of this technology into real-world settings is simple and inexpensive, IVR-based SBI could have a substantial public health impact.
This research is highly relevant to public health because the programs we are testing will increase the number of primary care patients who are appropriately advised about healthy alcohol use. The IVR-Screen will make patient information regarding drinking and other health matters more readily available to their primary care providers, thus enhancing patient-provider interaction. The IVR-BI, which will be accessible outside of the primary care office, will allow a larger number of patients to receive important information and advice on changing their drinking habits.
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