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BACKGROUND/RATIONALE:
Alcohol screening, followed by brief interventions for patients who screen positive, has been designated one of the highest primary care prevention priorities for the US. However, there are many barriers to providing such interventions to all primary care patients, and experts have suggested that alcohol screening and brief intervention (SBI) might be offered over the Internet. A recent randomized controlled trial demonstrated the efficacy of an eSBI program in young adults in Australia.
OBJECTIVE(S):
Specific Aims. The purpose of this HSRD Short Term Project is to adapt the efficacious Australian eSBI program for US veteran outpatients, revise it based on expert feedback, and pre-test the adapted eSBI program with a small number of OEF/OIF veterans. The specific aims will be to:
1. Determine US and VA drinking norms for use in eSBI feedback;
2. Adapt an efficacious Australian eSBI program for use by VA outpatients and revise it based on expert feedback; and
3. Identify potential barriers and facilitators of the eSBI program in a small pretest with nine OEF/OIF Veterans.
METHODS:
For Aim 1 we will analyze national US and VA population-based data to develop feedback for use in eSBI. The feedback to patients in the eSBI program includes criterion feedback on the severity of alcohol misuse (hazardous, harmful or dependent drinking) and normative feedback comparing the patient's drinking level to population norms. For criterion feedback we will use data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC) to identify ranges of alcohol screening scores (AUDIT-C Risk Zones) indicative of hazardous, harmful and dependent drinking. AUDIT-C Risk Zones will be derived using stratum-specific likelihood ratio methodology assessing the risk of alcohol dependence associated with each score. For normative feedback, we will determine age- and sex-stratified estimates of mean drinking measures (NESARC) and age- and sex-stratified proportions of VA patients screening at or above each positive score on the AUDIT-C using the VA's Survey of Healthcare Experiences of Patients (SHEP). For Aim 2, we will adapt the eSBI intervention for US patients, elicit expert feedback using semi-structured interviews, and beta-test the adapted eSBI program, revising it as needed. For Aim 3, we will pretest the adapted eSBI program with 9 OEF/OIF patients, followed by interviews which will be qualitatively analyzed using semi-structured template analysis. The eSBI program will undergo iterative revisions based on results of pre-testing.
FINDINGS/RESULTS:
There are no findings specific to this study to date. Web-based SBI has the potential to reach a broad audience and provide confidential SBI. Moreover, if eSBI is as efficacious as SBI by a provider, it would be a cost-effective alternative. The proposed study will result in an eSBI program that will be piloted and subsequently evaluated in a randomized controlled trial.
IMPACT:
Web-based SBI is anonymous and could be wide-reaching and cost-effective. The proposed study will result in an eSBI program that will be evaluated in a subsequent randomized controlled trial after further pilot testing. Although eSBI will be tested initially while patients wait to see their providers and results will not be integrated into CPRS or shared with providers, future integration is possible since the program will be based on screening with the AUDIT-C. Therefore, subsequent studies could evaluate eSBI when integrated with clinical AUDIT-C screening in CPRS or with online services provided through MyHealtheVet. Although we are pre-testing the eSBI program in OEF/OIF patients because they are at high risk for alcohol misuse and they are young, employed and web savvy, other clinics in our facility have expressed interest in the program, suggesting it could have broad applications.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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