Primary-Care Consultation Can Help Problem Drinkers

Few patients with alcohol-use problems who might benefit from either pharmacotherapy or specialized addiction treatment actually receive care. A pilot study which examined the feasibility of providing a real-time video consultation resource in primary care could increase the number who seek treatment.

"Relatively few patients initiate specialty treatment for alcohol use problems," said Stacy Sterling, research scientist at the Kaiser Permanente Northern California Division of Research, "however, primary care would provide an opportune setting. To my knowledge, this is the only study that has examined the feasibility of a real-time video consultation resource for primary care, which would include motivational interviewing and information about psychosocial and medication-assisted treatment options." Sterling discussed these findings at the 44th annual scientific meeting of the Research Society on Alcoholism.

Video Consultations

The one-year feasibility study was conducted in adult primary care at Kaiser Permanente Northern California. Sterling and her co-researchers developed and implemented video consult workflows, continuing medical education trainings, an on-call staffing protocol, and ongoing technical assistance.

"If a primary-care physician was seeing a patient whom they felt might benefit from consultation," said Sterling, "they would engage the services. This might be for a patient whose alcohol-screening responses suggested a probable alcohol use disorder, or perhaps someone with an ongoing history of alcohol-related medical conditions but who had not yet been interested in initiating specialty addiction treatment."

Services could range from helping to assess the patient's alcohol use and motivation to quit or cut back, to providing advice about alcohol anti-craving medications, to offering motivational interviewing-informed techniques to help guide the patient's decision making about specialty treatment, to following up with patients to see how they were doing.

Feasible and Helpful

"Primary-care physicians, staff and patients all seemed to like the service and find it both feasible and helpful," said Sterling. "In addition, although the pilot was a feasibility study and not powered to test patient outcomes, we had very promising findings in terms of both specialty addiction treatment initiation and alcohol pharmacotherapy initiation.

"Furthermore, we received excellent input about how the service could be improved and expanded to better meet the needs of clinicians and patients." This input will help inform future research, she added.

"Many in the alcohol field believe strongly that primary-care physicians, who are adept at dealing with a wide range of other chronic medical conditions, are well-suited to treat many alcohol use problems in primary care." said Sterling. "We hope that our findings will encourage primary-care practices and health systems hoping to expand their capacity to treat the spectrum of alcohol-use problems among their patients."

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