Individualized alcohol care management from a nurse in primary care does not reduce heavy drinking or improve alcohol-related outcomes even when patients are more involved in alcohol-related care, according to a study in JAMA.
Katharine A. Bradley, MD, of the Kaiser Permanente Washington Health Research Institute in Seattle, and associates conducted a randomized clinical trial at 3 Veterans Affairs (VA) primary care clinics to test the efficacy of 12 months of alcohol care management, compared with usual primary care, on drinking outcomes in patients at risk for alcohol use disorders (AUDs).
The Choosing Healthier Drinking Options in Primary Care (CHOICE) intervention trial consisted of 304 participants who reported heavy drinking, defined as 4 or more drinks per day for women and 5 or more drinks per day for men. Choice intervention included outreach and engagement with motivational interviews, repeated counseling, shared decision making about treatment options, and nurse practitioner–prescribed AUD medications, if requested.
The percentage of days that patients drank heavily in the 28 days before phone interviews and lack of alcohol-related symptoms in 3 months were the primary outcomes.
The average participant age was 51.4 years, 90% were male, and 68% were white; 150 participants were in the CHOICE intervention and 154 were in the control group, receiving usual primary care.
At the initiation of the study, both groups reported heavy drinking on 61% of days, and 91% of CHOICE trial participants (n= 137) had at least 1 nurse visit; 51% (n= 77) had at least 6 nurse visits. Compared with the 26% patients in the control group, 42% received alcohol-related care. More participants in the case group were administered AUD medication (32%) compared with the control group (8%).
The percentages of heavy drinking days for the CHOICE group and control group were 39% and 35%, respectively; good drinking outcomes were 15% and 20% in the intervention and control groups, respectively. Primary outcomes between both groups at 12 months were insignificant.
“The CHOICE intervention engaged patients in alcohol-related care and increased use of AUD medications,” reported the investigators.
“However, the nurse care management intervention did not decrease drinking more than usual care. Patient-centered interventions that recommend a goal of abstinence and engage most patients in medication use and/or offer brief therapy for AUDs appear most effective,” continued the authors. “Future research should evaluate whether these interventions improve functioning and health outcomes, as well as patient-reported drinking outcomes.”
Bradley KA, Bobb JF, Ludman EJ, et al. Alcohol-related nurse care management in primary care: a randomized clinical trial. [Published online March 26, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.0388