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Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.
Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers.
DESIGN:
Randomized controlled clinical trial with 12-month follow-up.
SETTING:
A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties.
PARTICIPANTS:
Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures.
INTERVENTION:
The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information.
MAIN OUTCOME MEASURES:
Alcohol use measures, emergency department visits, and hospital days.
RESULTS:
There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01).
CONCLUSIONS:
This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.
The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice.
METHODS:
We performed a controlled clinical trial with 6- and 12-month follow-up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high-risk drinking. A fourth site was added later. From the group that was screened, 530 high-risk drinkers entered into the study, with 447 providing follow-up at 12 months. The intervention consisted of brief (5-10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials.
RESULTS:
At 12-month follow-up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=-5.7 drinks per week; UC=-3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC.
CONCLUSIONS:
Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.
Guided Self-Change Healthy Lifestyles Program. The Guided Self-Change (GSC) Healthy Lifestyles outpatient program at Nova Southeastern University's (NSU) College of Psychology offers a unique short-term, evidence-based, non-12 step alternative treatment not available elsewhere in Florida. The GSC program has been recognized in the Surgeon General's report Facing Addiction in America (November 2016) as an appropriate treatment for individuals who have mild alcohol or drug problems. It also is included on the American Psychological Association's (APA) Division 12 (Society of Clinical Psychology) website listing of Empirically Supported Treatments.
