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Article Title

Alcohol Screening and Brief Intervention and Improved Health Outcomes in Hypertensive Patients: Results From an Implementation Study in Primary Care Setting

Publication Date

8-15-2016

Keywords

alcohol screening and brief intervention, hypertension

Abstract

Background/Aims: Many hypertensive patients drink at levels above recommended limits, which is associated with adverse blood pressure changes. Alcohol screening and brief intervention in adult primary care has been found efficacious in reducing hazardous drinking, yet little is known about the impacts on health outcomes. This study aims to evaluate the effect of alcohol screening and brief intervention on blood pressure control among adult hypertensive patients by analyzing data of the ADVISe study, a clustered randomized controlled trial on Screening, Brief Intervention, and Referral to Treatment (SBIRT) implementation by primary care physicians (PCP) and nonphysician providers in a large, integrated health care delivery system.

Methods: This observational prospective cohort study examined electronic health record data during 2-year follow-up on 4,086 hypertensive primary care patients 18+ years old who screened positive for past-year risky drinking at baseline, of which 1,478 had a blood pressure measure at both the index screen and 18-month follow-up (36%). We examined associations between documented brief intervention and change in blood pressure by fitting general linear models and addressed issues of potential selection and attrition bias by using inverse probability weighting.

Results: Findings suggested a positive association between receiving brief intervention for positive hazardous drinking screen and better blood pressure control at 18 months for those in the PCP arm, for those with less severe drinking level at index screen and for those with poor blood pressure control at the index screen. For hypertensive patients with systolic/diastolic blood pressure at 140+/90+ mmHg who reported 1–7 hazardous drinking days in the past year, the adjusted mean decline of systolic blood pressure was 37.9 mmHg for those who received brief intervention compared to 17.2 mmHg among those who did not receive brief intervention (P = 0.0003). For those in the PCP arm who had less severe drinking level at index screen, those who received brief intervention had 10 times higher odds of having hypertension under control than those who did not.

Conclusion: Preliminary results suggest that alcohol screening and brief intervention may be beneficial for adult primary care patients with hypertension.

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