Alcohol misuse (AMU) inflicts high costs on individuals and society. Timely intervention can be effective in reducing the impact, but AMU is rarely identified and treated in practice. Although AMU afflicts young, healthy people, it also frequently occurs superimposed on psychosocial problems, which are also frequently not identified. The common thread is that physicians lack the time and resources for a complete assessment and for appropriately treating biopsychosocial and health behavioral issues that are discovered. A central tenet of psychometrics is that if you want to know what is going on with the patient, you must ask the patient-not a provider and not the chart. If you want to know about AMU, patients must be asked directly;providers will not know and paper questionnaires cannot be scaled into an effective solution. SOLUTION: Our work builds on an operational, Web-based, patient self-assessment system called CarePrep that allows patients to easily enter and track symptom, psychosocial, and QOL data over the Internet from home or clinic. APPROACH: (1) We will deploy CarePrep in a primary care clinic, addressing any policy and procedural issues and fitting the system into the pathway of care, with the goal of assessing patients before their clinic visit. Patient testing will be conducted to identify and resolve problems with use and to start data collection for the Aim 2 validation. (2) Working with alcohol and psychometric experts, we will extend and validate CarePrep to screen for and assess AMU in the context of patients'bio-psychosocial issues. We will build on established instruments like the AUDIT and on established domains and items, focusing on early identification and assessment of dependency and consequences from AMU. High priority is placed upon generating value in medical settings, so that the system gets used. Clinical relevance and construct validity will be assessed. We will assess feasibility and acceptance by providers and patients. IMPACT: (1) Initial development and validation of an online resource capable of identifying and assessing AMU in the context of relevant biopsychosocial issues. (2) A integrated intervention that embeds screening and a brief intervention for AMU into the pathway of routine medical care, creating value for providers and patients so that the system gets used. (3) The core of a consensus resource for research that turns routine clinical encounters into research opportunities and supports relevant, transparent investigation of AMU.
This work adapts a web-based, patient self-assessment system that is now in operation in clinic to identify and assess alcohol misuse in medical settings in the context of the patients'medical and psychosocial issues. Since medical physicians frequently do not have the time to assess and provide brief interventions and continuing care, the online system will be developed to operate as independently as possible to support care, informing the clinician of the patient's status and problems. We propose to develop the questions for the assessment and then to test their validity with patients and whether use is acceptable to patients and physicians. Long-range goals are to establish that this approach improves care for alcohol misuse.
