This is an R21 application for an exploratory /developmental study of Interactive Voice Response (IVR) as a tool for automated screening and brief intervention for heavy/problem drinking in primary care settings. There is overwhelming evidence that a brief alcohol intervention (Bl) by a primary care provider is effective in reducing at-risk drinking among patients. But, there is also evidence that screening and Bl are grossly underutilized by primary care providers. ? ? Possible explanations include lack of time, lack of provider awareness of their patients' consumption level, provider discomfort with behavioral interventions, provider doubts about the efficacy of Bl, and lack of reimbursement for preventive services. The results of studies testing the impact of targeted education and/or provider encouragement have been disappointing. In response, there have been calls for automating screening and brief intervention. Most efforts so far have been computer based and not widely tested in primary care settings. While computer-based approaches are worthy of further pursuit, they are not an ideal solution. Computerization requires on-site computer hardware and software, technical support, and clinic staff time to initiate the screening & Bl with patients, some of whom may be intimidated by computers. This is an ongoing financial investment that discourages use in most clinics. ? ? This R21 application is for an exploratory effort to test a telephone technology (IVR) as a method of alcohol screening and brief intervention that is inexpensive, uses a familiar and nearly universal technology (touch-tone telephones), and requires essentially no clinical staff time. If this developmental project is successful, we will use the resulting data as a basis for a subsequent randomized controlled trial of the efficacy of IVR-based Bl compared to Bl done by primary care providers. Methods: The study will be done in two phases. In Phase I, we will create an IVR-based screening tool (IVR-Screen) that is acceptable to patients, utilitarian for providers, and valid for identifying patients who are appropriate for brief intervention. After completing Phase I, in Phase II we will develop an IVR-based brief intervention tool (IVR-BI) and test its acceptance among clinic patients who are positive on the IVR-Screen and are appropriate for alcohol brief intervention. Although this is not an efficacy study, we will also assess whether the IVR-BI has a short-term impact on alcohol consumption in this small feasibility sample. ? ? ?
