The effectiveness of patient-centered computer assisted telephone methods and primary care provider-centered feedback and training to enhance community-based alcohol-related screening and intervention will be examined in a 25-month randomized controlled trial of approximately 12,000 patients at MetroHealth Medical Center in Cleveland, OH. The three primary (1-3) and three secondary aims (4-6) are:
Aim 1) Demonstrate the effectiveness of a Computer Assisted Telephone Interview with Feedback (CATI-F) to increase detection of alcohol problems;
Aim 2) Test the incremental effectiveness, beyond CATI-F, of Computer Assisted Telephone Patient Services (CATI-F/PS) to improve follow-up and outcomes of detection of alcohol problems;
Aim 3) Test the incremental effectiveness, beyond that obtained by CATI-F/PS of primary care physician training in brief interventions to improve recognition and follow-up of alcohol problems;'Aim 4) Compare medical resource utilization across the three study groups:
Aim 5) Compare the sociodemographic and clinical characteristics of patient """"""""users' and """"""""non-users"""""""" of the CATI interventions;
Aim 6) Describe strategies and techniques of physician intervention in each Study Group. Patients and providers are assigned randomly to parallel group practices, or 'Firms,"""""""" which provide the basis for study group assignment. Patients in Group 1 will only be offered CATI-F with alcohol screening results provided to patients and their physicians. Patients in Group 2 also will be offered telephone accessible Patient Services (CATI-F/PS), including voice mail bulletin boards and access to regional resources in health, religious, and alcohol treatment communities. Patients in Group 3 (CATI-F/PS/T) will be offered CATI-F and the Group 2 services, but their physicians will be trained in brief interventions designed to improve alcohol problem recognition and follow-up, Changes in survey scores, use of hospital-or community-based alcohol treatment resources, and interval hospitalizations will be assessed at 3 and 9 months. We expect improved alcohol screening in all groups, and that physician training will add to CATIF/PS in effecting the greatest changes in survey scores, treatment, and resource utilization. The successful use of these innovative methods will have great relevance to primary care physicians, their patients, and to managed care organizations and other payors for health care services.
