2023. Primary Care Providers Predominantly Advise At-risk Drinkers to Abstain
Katharine A Bradley, MD, MPH, VA Puget Sound Healthcare System and University of Washington, D Kivlahan, VA Puget Sound Healthcare System and University of Washington, CE Achtmeyer, VA Puget Sound Healthcare System and University of Washington, EC Williams, VA Puget Sound Healthcare System and University of Washington, KA McCormick, VA Puget Sound Healthcare System and University of Washington, J Merrill, VA Puget Sound Healthcare System and University of Washington, M Burman, VA Puget Sound Healthcare System and University of Washington, M McDonell, VA Puget Sound Healthcare System and University of Washington, SD Fihn, VA Puget Sound Healthcare System and University of Washington

Objectives: Current evidence suggests that most patients who report at-risk drinking should be advised to drink below recommended limits, while advice to abstain is reserved for the minority of at-risk drinkers with alcohol dependence or medical contraindications to drinking. We sought to determine whether alcohol counseling provided in VA primary care clinics corresponds with these recommendations.

Methods: The study population included VA outpatients from 7 general medicine clinics. Participants completed mailed surveys that included a validated alcohol screening questionnaire to identify past-year hazardous or problem drinking, and questions about receipt of alcohol-related advice from a primary care provider. Multivariable hierarchical logistic regression was used to model the odds of advice to abstain among patients who reported receiving alcohol-related advice in the past year.

Results: Only 1,554 of 5,191 patients with hazardous or problem drinking (30%) reported receiving any alcohol-related advice in the past year, and most of those (73%) reported advice to abstain. The odds of receiving advice to abstain were highest among patients with the highest and lowest AUDIT scores, those who reported alcohol treatment in the past year (3.2; 1.7-5.9) or anytime previously (1.4; 1.0-2.0), or who reported liver disease (3.10; 1.7-5.6). Even among patients in the lowest risk groups, the majority who received advice reported being advised to abstain.

Conclusions: Veterans in VA primary care clinics do not routinely receive appropriate alcohol-related advice.

Impact: Additional research is needed to investigate effective strategies for implementing evidence-based approaches to alcohol counseling in VA primary care.