Alcohol-related intervention reduces drinking, BP; no effect on type 2 diabetes
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A brief alcohol-related intervention in people with unhealthy alcohol use was linked to reduction of diastolic BP in patients with hypertension but did not improve outcomes in patients with type 2 diabetes, researchers reported.
The researchers assessed the performance of Kaiser Permanente Northern California’s Alcohol as a Vital Sign initiative on 72,979 patients with hypertension (mean age, 62 years; 68% men) and 19,642 patients with diabetes (mean age, 60 years; 79% men) who screened positive for unhealthy alcohol use between 2014 and 2017.
Alcohol-use screening and intervention
“The Alcohol as a Vital Sign initiative we implemented in the Kaiser Permanente Northern California health system came about serendipitously about 10 years ago. Our research team had already been studying how to address hazardous alcohol use in primary care from a variety of angles, including a large National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded trial of the most effective ways to deliver Screening, Brief Intervention and Referral to Treatment (known as SBIRT),” Stacy A. Sterling, DrPH, MSW, co-director of the Center for Addiction and Mental Health Research at the Kaiser Permanente Division of Research, told Healio. “As that trial’s preliminary finds were emerging, the health system was revamping the tool in the electronic health record that medical assistants use to ‘room’ patients when they come in for primary care visits. Health system leaders recognized the importance of screening for unhealthy alcohol use, and there was an opportunity to get evidence-based screening tools into regular practice, and train primary care physicians to deliver brief interventions using the approaches that we had found to be most effective, so the initiative was implemented across the system beginning in June 2013. Since that time, over 16 million alcohol screenings have been conducted, and over 1 million brief interventions for unhealthy drinking have been delivered.”
Those who screened positive for unhealthy drinking were offered the brief intervention, which consisted of motivational interviewing and, if necessary, a referral to outpatient addiction medicine treatment. The EHR system reminded medical assistants to screen patients annually, except in the cases of people who had a prior positive screen, in which case a reminder was sent every 6 months until there was a negative screen.
The drinking-related outcomes were changes between baseline and 12 months in heavy drinking days in the past 3 months, number of drinking days per week, number of drinks per drinking days and number of drinks per week. The hypertension-related outcomes were changes in systolic and diastolic BP and reduction in BP of at least 3 mm Hg at 18 months. In patients with diabetes, the researchers also assessed change in HbA1c and control of HbA1c (< 8%) at 18 months.
Impact on hypertension
In patients with hypertension, compared with those who did not have the intervention, those who did had a reduction in drinks per drinking day (–0.06; 95% CI, –0.11 to –0.01) and in drinks per week (–0.3; 95% CI, –0.59 to –0.01) at 12 months, according to the researchers.
In the hypertension cohort, those who had the intervention were more likely to have a clinically meaningful reduction in diastolic BP at 18 months compared with those who did not (OR = 1.05; 95% CI, 1-1.09), Sterling and colleagues wrote.
In the diabetes cohort, there was no difference between those who did and did not participate in the intervention in drinking, BP and HbA1c outcomes, according to the researchers.
“People with hypertension who drank alcohol at unhealthy levels who received a brief intervention from their primary care physician were more likely to see clinically significant reductions in their blood pressure,” Sterling told Healio. “This is one of only a few studies that have looked at alcohol brief interventions and health conditions beyond drinking, and as we learn more about its positive health benefits, health care providers have an opportunity to think about all the ways it can be incorporated as a standard component of their approach to preventive health care, alongside healthy eating, getting adequate exercise and smoking cessation. Alcohol screening and brief intervention is an effective and inexpensive tool that can be added to the toolkit that primary care physicians have for helping their patients control their blood pressure.”
The researchers are now investigating the impact of alcohol screening and brief intervention on other chronic conditions, Sterling told Healio.
For more information:
Stacy A. Sterling, DrPH, MSW, can be reached at stacy.a.sterling@kp.org.
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