Brief Intervention in Primary Care: Does It Really Work in Practice?

Although the efficacy of brief intervention (BI) for unhealthy alcohol use in primary care patients is established, important implementation questions remain (e.g., who should deliver a BI?; how effective is BI in general clinical practice?). To address these issues, researchers evaluated BI among a randomly selected sample of adult risky drinkers* in 15 clinics within 5 managed care organizations.

Clinics were randomly assigned to provide 1 of the following: BI by licensed practitioner (MD, NP); BI by mid-level professional (nurse); or no BI. Follow-up was completed by 1329 subjects (of 2923) at 3 months and 737 at 12 months.

• At 3 months, patients who received BI as well as those who did not had significant decreases in consumption from baseline.
• A greater proportion of intervention than control patients decreased consumption by >=1 drinks per week (60% vs. 53%).
• Decreases and differences between groups persisted at the 12-month follow-up.
• Provider type (licensed or mid-level) did not significantly affect the results.
• The estimated cost of BI ranged between $2.82 and $4.16.

Comments:

This effectiveness study had substantial loss to follow-up. Still, its findings suggest that BI can be implemented at a defined cost in managed-care primary care settings and may produce modest decreases in alcohol consumption, whether delivered by a physician, nurse practitioner, or nurse. No cost-effectiveness outcomes were described despite the article’s title.

Reference:

Babor TF, Higgins-Biddle JC, Dauser D, et al. Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Alcohol Alcohol. 2006;41(6):624–631.