Rates and Impact of Adherence to Recommended Care for Unhealthy Alcohol Use

Published in: Journal of General Internal Medicine, Volume 34, Issue 2 (February 2019), Pages 256-263. doi:10.1007/s11606-018-4749-3

Posted on RAND.org on March 07, 2019

by Kimberly A. Hepner, Susan M. Paddock, Katherine E. Watkins, Katherine Hoggatt, Lisa V. Rubenstein, Andy Bogart, Praise O. Iyiewuare, Susan Rosenbluth, Harold Alan Pincus

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Unhealthy alcohol use is a major worldwide health problem. Yet few studies have assessed provider adherence to the alcohol-related care recommended in clinical practice guidelines, nor links between adherence to recommended care and outcomes.


To describe quality of care for unhealthy alcohol use and its impacts on drinking behavior.

Research Design

Prospective observational cohort study of quality of alcohol care for the population of patients screening positive for unhealthy alcohol use in a large Veterans Affairs health system.


A total of 719 patients who screened positive for unhealthy alcohol use at one of 11 primary care practices and who completed baseline and 6-month telephone interviews.

Main Measures

Using administrative encounter and medical record data, we assessed three composite and 21 individual process-based measures of care delivered across primary and specialty care settings. We assessed self-reported daily alcohol use using telephone interviews at baseline and 6-month follow-up.

Key Results

The median proportion of patients who received recommended care across measures was 32.8% (range = 1% for initiating pharmacotherapy to 93% for depression screening). There was negligible change in drinking for the study population between baseline and 6 months. In covariate-adjusted analyses, no composites were significantly associated with changes in heavy drinking days or drinks per week, and just one of nine individual measures tested was significantly associated. In a subsample of patients drinking above recommended weekly limits prior to screening, two of nine individual measures were significantly associated.


This study shows wide variability in receipt of recommended care for unhealthy alcohol use. Receipt of recommended interventions for reducing drinking was frequently not associated with decreased drinking. Results suggest deficits in provision of comprehensive alcohol care and in understanding how to improve population-based drinking outcomes.

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