If Trained and Prompted, Will Primary Care Clinicians Offer Relapse Prevention?
Clinical assistance to help prevent relapse in patients with past alcohol problems is not the norm in primary care practice. In this study, 18 clinicians in 2 primary care offices were randomized to provide usual care or to receive training on relapse prevention (i.e., initial sessions on maintenance care for patients in remission, an academic detailing luncheon, and a booster session) and chart prompts at eligible* patients’ visits.
Patients were interviewed (n=164) after a visit with their clinician to determine their satisfaction with the visit and whether the clinician asked about their drinking history, assessed prior and planned treatment, or offered prescriptions or treatment referrals.
- The training significantly improved clinicians’ confidence in assessing and counseling patients in remission.
- In multivariable analyses adjusted for age and score on the CAGE alcohol screening test, intervention clinicians were more likely than control clinicians to ask patients about their history of alcohol issues (odds ratio 2.8).
- Intervention clinicians who asked patients about their alcohol history were also more likely to discuss prior and planned alcohol treatment and to offer prescriptions and treatment referrals.
- Patients of intervention clinicians who were asked about alcohol use reported the greatest satisfaction with the visit.
This study, unique in its exclusive focus on maintenance care for primary care patients with past unhealthy alcohol use, does not allow readers to determine the independent effect of training versus prompting. Nevertheless, it does suggest that these methods may increase the likelihood that clinicians will help prevent their patients in recovery from relapsing.Jeffrey H. Samet, MD, MA, MPH
Friedmann PD, Rose J, Hayaki J, et al. Training primary care clinicians in maintenance care for moderated alcohol use. J Gen Intern Med. 2006; 21(12):1269–1275.