This application proposes a project that will improve primary care practitioners' recognition and management of patients with alcohol dependence and abuse and improve the outcomes of patients diagnosed with these disorders. After their participation in a series of educational workshops on alcoholism, all 30 first year internal medicine trainees practicing in the Primary Care Associates Group practice at the Medical College of Virginia will be randomly assigned to either an intervention group that will receive feedback on their patients diagnosed as alcoholic by DSM III-R criteria using the Diagnostic Interview Schedule (DIS) or a control group that will receive no such feedback. The feedback will include the patient's diagnosis, symptom criteria upon which the diagnosis is based and recency of last reported symptom, reported estimate of alcohol consumed per week and recency of last reported drink and guidelines for the patient's management. Physician recognition and management of patients diagnosed with dependence or abuse will be evaluated during a 12 month period of feedback and for six months after cessation of feedback in the following manner: Post patient visit interviews to assess degree of intervention, medical record review for physician recording of alcohol problems and their management, frequency of patient referral to a clinic based rehabilitation counselor and scores on a structured substance abuse attitude survey modified for alcoholism. Statistical analysis will be applied to any differences in measures of attitudes and clinical performance between the feedback group of physicians and the control group of physicians. The effectiveness of physician intervention on patient outcome will be statistically analyzed using the following variables: Duration of symptom free interval on retest with the DIS, quantity of alcohol consumed, functional status as measured by the Sickness Impact Profile, patient health service utilization, and Gamma Glutamyl Transpeptidase enzyme activity.
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