Alcohol use exacerbates chronic health conditions such as hypertension and type 2 diabetes. Brief interventions at primary care visits may help patients with these health conditions reduce their alcohol use and improve their overall health and well-being. This study examined the impact of a brief intervention on drinking and relevant health outcomes in patients with hypertension or type 2 diabetes.
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Hypertension and type 2 diabetes are highly prevalent chronic health conditions in the US- over 30 million Americans have diabetes and over 100 million Americans have hypertension. Alcohol use is known to exacerbate these chronic health conditions. Given that most people with hypertension and/or diabetes manage these conditions via primary care, these visits provide a key opportunity to address unhealthy alcohol use.
Brief Interventions in primary care settings have been recommended to help address alcohol use among patients, but evidence for the efficacy of brief interventions at reducing unhealthy alcohol use and health outcomes has been mixed.
The current research examined associations between receiving a brief intervention designed to reduce alcohol use and 12-month drinking and 18-month health outcomes among adult patients with hypertension and type 2 diabetes who screened positive for unhealthy alcohol use during a primary care visit.
This study was a population-based observational study using electronic health records data of patients in the Kaiser Permanente Northern California healthcare system. Participants included in the analyses (N=92,621) were patients with hypertension or type 2 diabetes who had screened positive for unhealthy alcohol use at a primary care visit between 2014-2017.
Unhealthy alcohol use was defined as drinking that exceeded 7 drinks per week for women and men aged 66 and older, or >14 drinks per week for men aged 18–65. Patients were excluded from the analyses if they (1) did not have continuous Kaiser Permanente healthcare system membership in the year prior to baseline date; (2) were older than 85 years of age at baseline; or (3) did not have complete baseline alcohol screening data.
The intervention used in the current study was a physician administered brief intervention based on motivational interviewing principles. This included referrals to outpatient addiction medicine treatment. No other information about the brief intervention was provided by the authors.
The primary outcome was alcohol use behavior 12 months post-intervention. Alcohol use was measured in 4 ways: number of heavy drinking days over the past 3 months, number of drinking days per week, drinks per drinking day, and drinks per week from baseline to 12-month follow-up. These behaviors were measured via alcohol screening conducted at primary care visits. The study also examined health outcomes at 18 months post-intervention. These health measures were systolic and diastolic blood pressure and blood sugar (i.e., glycohemoglobin [HbA1c] level and ‘controlled HbA1c’ [HbA1c<8%]) at 18-month follow-up for patients with type 2 diabetes. The authors defined a clinically meaningful improvement in blood pressure to be ≥3 mm Hg reduction from baseline at 18 months. All outcomes were measured as part of routine care visits, and thus were derived from participants’ electronic health records. Because this was a naturalistic study using electronic health records only, follow-up time points were approximate (e.g., drinking measured at the 12-month follow-up was as close to 12 months post-intervention as possible).
The researchers used statistical modeling to compare drinking outcomes at 12 months and health outcomes at 18 months between patients who received the brief intervention and those who did not. The researchers used a statistical modeling technique to adjust for variables associated with receiving the brief intervention and the outcomes (drinking and health outcomes). This analytic method allowed the researchers to account for as many alternative explanations of a potential positive effect of brief intervention as possible, thereby increasing confidence that the intervention caused the positive effects on drinking and/or health outcomes.
Participants included individuals with hypertension (n=72,979) and type 2 diabetes (n=19,642). The majority were male (67.5% and 79.0% for the hypertension group and diabetes group respectively). On average, participants with hypertension were 62 years of age while the average age of participants with type 2 diabetes were60. Most participants were non-Hispanic White (70.5% and 52.8%). At baseline about 17% and 15% of participants reported drinking at levels exceeding daily and weekly limits, respectively. Approximately 5% of participants in both samples had an alcohol use disorder diagnosis. Roughly 17% and 15% of participants with hypertension and type 2 diabetes had co-occurring mental health conditions in the prior year, respectively.
Brief interventions reduced alcohol use only for certain subgroups.
All participants drank less alcohol 12 months post-baseline visit regardless of whether they received the brief intervention. However, for those who exceeded only daily drinking limits at baseline, the brief intervention showed greater reduced alcohol use for all 4 outcomes at 12 months. Hypertension patients who exceeded only weekly alcohol limits or those exceeding both daily and weekly alcohol limits drank at similar levels did not benefit from the brief intervention.
Figure 1. All participants drank less compared to their baseline levels regardless of receiving the brief intervention, but differences were seen in changes in drinking levels between those who received the brief intervention and those who didn’t.
Only patients with type 2 diabetes aged 30-44 drank less after receiving the brief intervention.
All other participants with type 2 diabetes had similar alcohol use reductions whether they received the brief intervention or not.
Receiving the brief intervention was associated with reduced blood pressure only among hypertensive patients.
Among patients with hypertension, those who received a brief intervention had an additional decline in blood pressure at 18 months compared with those who did not. Receiving the brief intervention was associated with a 5% greater likelihood of clinically meaningful improvement. The researchers did not observe an association between getting the brief intervention and blood pressure among patients with type 2 diabetes. There was no impact on blood sugar levels for those with diabetes.
The results of the study suggest that an alcohol-focused brief intervention delivered in a primary care setting can impact alcohol use and chronic health conditions among specific types of patients with chronic health conditions.
The researchers found that all participants drank less alcohol 12 months post-baseline visit regardless of if they received the brief intervention or not. Participants with hypertension whose drinking exceeded daily drinking limits at baseline had greater reductions than other groups after receiving the intervention. Hypertension patients who exceeded only weekly limits or those exceeding both daily and weekly limits drank at similar levels as the rest of the sample post-intervention. Similarly, only patients with type 2 diabetes aged 30-44 showed more reductions in alcohol use 1-year post intervention. All other patients with type 2 diabetes showed similar reductions in drinking.
This pattern of results may suggest that the impact of brief interventions varies depending on patients’ characteristics. For example, the finding that only participants whose drinking exceeded daily drinking (but not weekly) limits at baseline drank less after receiving the intervention may suggest that regular heavier drinkers may be more open to the advice and feedback presented during brief interventions. Similarly, the fact that patients with type 2 diabetes saw no changes in alcohol use post intervention suggest that factors like type of chronic disease, disease severity, medication intensity and patient adherence to medications and lifestyle changes may play a role in brief interventions effectiveness. These findings suggest that different approaches, including tailoring to population subgroups or health conditions, may be needed to address unhealthy drinking and related health outcomes among patients with chronic conditions.
Results of this research suggest that a physician administered brief intervention can impact alcohol use and health outcomes among certain types of patients with chronic health conditions. The benefits of the brief intervention to address unhealthy alcohol use for individuals with hypertension and type 2 diabetes varied depending upon individual patient characteristics. Patients with type 2 diabetes aged 30-44 drank less after receiving the brief intervention, whereas all other participants with type 2 diabetes did not drink less alcohol 12 months post–intervention. Participants with hypertension who reported exceeding only daily drinking limits at baseline who received the intervention showed greater reduction on all drinking outcomes 12 months post-intervention. Hypertension patients who exceeded only weekly drinking limits or those exceeding both daily and weekly limits drank at similar levels as the rest of the sample post-intervention. These results suggest that brief interventions targeting alcohol use among primary care patients may not work well for all patients. For example, patients with more severe alcohol use may benefit less from brief interventions. Providers should consider individual patients’ unique demographics/behaviors when deciding to implement a brief intervention or to refer to more intensive treatment. More research is needed to corroborate these findings and test potential interventions.
Chi, F. W., Parthasarathy, S., Palzes, V. A., Kline-Simon, A. H., Weisner, C. M., Satre, D. D., . . . & Sterling, S. A. (2023). Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study. BMJ open, 13(1), e064088. doi: 10.1136/bmjopen-2022-064088
l
Hypertension and type 2 diabetes are highly prevalent chronic health conditions in the US- over 30 million Americans have diabetes and over 100 million Americans have hypertension. Alcohol use is known to exacerbate these chronic health conditions. Given that most people with hypertension and/or diabetes manage these conditions via primary care, these visits provide a key opportunity to address unhealthy alcohol use.
Brief Interventions in primary care settings have been recommended to help address alcohol use among patients, but evidence for the efficacy of brief interventions at reducing unhealthy alcohol use and health outcomes has been mixed.
The current research examined associations between receiving a brief intervention designed to reduce alcohol use and 12-month drinking and 18-month health outcomes among adult patients with hypertension and type 2 diabetes who screened positive for unhealthy alcohol use during a primary care visit.
This study was a population-based observational study using electronic health records data of patients in the Kaiser Permanente Northern California healthcare system. Participants included in the analyses (N=92,621) were patients with hypertension or type 2 diabetes who had screened positive for unhealthy alcohol use at a primary care visit between 2014-2017.
Unhealthy alcohol use was defined as drinking that exceeded 7 drinks per week for women and men aged 66 and older, or >14 drinks per week for men aged 18–65. Patients were excluded from the analyses if they (1) did not have continuous Kaiser Permanente healthcare system membership in the year prior to baseline date; (2) were older than 85 years of age at baseline; or (3) did not have complete baseline alcohol screening data.
The intervention used in the current study was a physician administered brief intervention based on motivational interviewing principles. This included referrals to outpatient addiction medicine treatment. No other information about the brief intervention was provided by the authors.
The primary outcome was alcohol use behavior 12 months post-intervention. Alcohol use was measured in 4 ways: number of heavy drinking days over the past 3 months, number of drinking days per week, drinks per drinking day, and drinks per week from baseline to 12-month follow-up. These behaviors were measured via alcohol screening conducted at primary care visits. The study also examined health outcomes at 18 months post-intervention. These health measures were systolic and diastolic blood pressure and blood sugar (i.e., glycohemoglobin [HbA1c] level and ‘controlled HbA1c’ [HbA1c<8%]) at 18-month follow-up for patients with type 2 diabetes. The authors defined a clinically meaningful improvement in blood pressure to be ≥3 mm Hg reduction from baseline at 18 months. All outcomes were measured as part of routine care visits, and thus were derived from participants’ electronic health records. Because this was a naturalistic study using electronic health records only, follow-up time points were approximate (e.g., drinking measured at the 12-month follow-up was as close to 12 months post-intervention as possible).
The researchers used statistical modeling to compare drinking outcomes at 12 months and health outcomes at 18 months between patients who received the brief intervention and those who did not. The researchers used a statistical modeling technique to adjust for variables associated with receiving the brief intervention and the outcomes (drinking and health outcomes). This analytic method allowed the researchers to account for as many alternative explanations of a potential positive effect of brief intervention as possible, thereby increasing confidence that the intervention caused the positive effects on drinking and/or health outcomes.
Participants included individuals with hypertension (n=72,979) and type 2 diabetes (n=19,642). The majority were male (67.5% and 79.0% for the hypertension group and diabetes group respectively). On average, participants with hypertension were 62 years of age while the average age of participants with type 2 diabetes were60. Most participants were non-Hispanic White (70.5% and 52.8%). At baseline about 17% and 15% of participants reported drinking at levels exceeding daily and weekly limits, respectively. Approximately 5% of participants in both samples had an alcohol use disorder diagnosis. Roughly 17% and 15% of participants with hypertension and type 2 diabetes had co-occurring mental health conditions in the prior year, respectively.
Brief interventions reduced alcohol use only for certain subgroups.
All participants drank less alcohol 12 months post-baseline visit regardless of whether they received the brief intervention. However, for those who exceeded only daily drinking limits at baseline, the brief intervention showed greater reduced alcohol use for all 4 outcomes at 12 months. Hypertension patients who exceeded only weekly alcohol limits or those exceeding both daily and weekly alcohol limits drank at similar levels did not benefit from the brief intervention.
Figure 1. All participants drank less compared to their baseline levels regardless of receiving the brief intervention, but differences were seen in changes in drinking levels between those who received the brief intervention and those who didn’t.
Only patients with type 2 diabetes aged 30-44 drank less after receiving the brief intervention.
All other participants with type 2 diabetes had similar alcohol use reductions whether they received the brief intervention or not.
Receiving the brief intervention was associated with reduced blood pressure only among hypertensive patients.
Among patients with hypertension, those who received a brief intervention had an additional decline in blood pressure at 18 months compared with those who did not. Receiving the brief intervention was associated with a 5% greater likelihood of clinically meaningful improvement. The researchers did not observe an association between getting the brief intervention and blood pressure among patients with type 2 diabetes. There was no impact on blood sugar levels for those with diabetes.
The results of the study suggest that an alcohol-focused brief intervention delivered in a primary care setting can impact alcohol use and chronic health conditions among specific types of patients with chronic health conditions.
The researchers found that all participants drank less alcohol 12 months post-baseline visit regardless of if they received the brief intervention or not. Participants with hypertension whose drinking exceeded daily drinking limits at baseline had greater reductions than other groups after receiving the intervention. Hypertension patients who exceeded only weekly limits or those exceeding both daily and weekly limits drank at similar levels as the rest of the sample post-intervention. Similarly, only patients with type 2 diabetes aged 30-44 showed more reductions in alcohol use 1-year post intervention. All other patients with type 2 diabetes showed similar reductions in drinking.
This pattern of results may suggest that the impact of brief interventions varies depending on patients’ characteristics. For example, the finding that only participants whose drinking exceeded daily drinking (but not weekly) limits at baseline drank less after receiving the intervention may suggest that regular heavier drinkers may be more open to the advice and feedback presented during brief interventions. Similarly, the fact that patients with type 2 diabetes saw no changes in alcohol use post intervention suggest that factors like type of chronic disease, disease severity, medication intensity and patient adherence to medications and lifestyle changes may play a role in brief interventions effectiveness. These findings suggest that different approaches, including tailoring to population subgroups or health conditions, may be needed to address unhealthy drinking and related health outcomes among patients with chronic conditions.
Results of this research suggest that a physician administered brief intervention can impact alcohol use and health outcomes among certain types of patients with chronic health conditions. The benefits of the brief intervention to address unhealthy alcohol use for individuals with hypertension and type 2 diabetes varied depending upon individual patient characteristics. Patients with type 2 diabetes aged 30-44 drank less after receiving the brief intervention, whereas all other participants with type 2 diabetes did not drink less alcohol 12 months post–intervention. Participants with hypertension who reported exceeding only daily drinking limits at baseline who received the intervention showed greater reduction on all drinking outcomes 12 months post-intervention. Hypertension patients who exceeded only weekly drinking limits or those exceeding both daily and weekly limits drank at similar levels as the rest of the sample post-intervention. These results suggest that brief interventions targeting alcohol use among primary care patients may not work well for all patients. For example, patients with more severe alcohol use may benefit less from brief interventions. Providers should consider individual patients’ unique demographics/behaviors when deciding to implement a brief intervention or to refer to more intensive treatment. More research is needed to corroborate these findings and test potential interventions.
Chi, F. W., Parthasarathy, S., Palzes, V. A., Kline-Simon, A. H., Weisner, C. M., Satre, D. D., . . . & Sterling, S. A. (2023). Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study. BMJ open, 13(1), e064088. doi: 10.1136/bmjopen-2022-064088
l
Hypertension and type 2 diabetes are highly prevalent chronic health conditions in the US- over 30 million Americans have diabetes and over 100 million Americans have hypertension. Alcohol use is known to exacerbate these chronic health conditions. Given that most people with hypertension and/or diabetes manage these conditions via primary care, these visits provide a key opportunity to address unhealthy alcohol use.
Brief Interventions in primary care settings have been recommended to help address alcohol use among patients, but evidence for the efficacy of brief interventions at reducing unhealthy alcohol use and health outcomes has been mixed.
The current research examined associations between receiving a brief intervention designed to reduce alcohol use and 12-month drinking and 18-month health outcomes among adult patients with hypertension and type 2 diabetes who screened positive for unhealthy alcohol use during a primary care visit.
This study was a population-based observational study using electronic health records data of patients in the Kaiser Permanente Northern California healthcare system. Participants included in the analyses (N=92,621) were patients with hypertension or type 2 diabetes who had screened positive for unhealthy alcohol use at a primary care visit between 2014-2017.
Unhealthy alcohol use was defined as drinking that exceeded 7 drinks per week for women and men aged 66 and older, or >14 drinks per week for men aged 18–65. Patients were excluded from the analyses if they (1) did not have continuous Kaiser Permanente healthcare system membership in the year prior to baseline date; (2) were older than 85 years of age at baseline; or (3) did not have complete baseline alcohol screening data.
The intervention used in the current study was a physician administered brief intervention based on motivational interviewing principles. This included referrals to outpatient addiction medicine treatment. No other information about the brief intervention was provided by the authors.
The primary outcome was alcohol use behavior 12 months post-intervention. Alcohol use was measured in 4 ways: number of heavy drinking days over the past 3 months, number of drinking days per week, drinks per drinking day, and drinks per week from baseline to 12-month follow-up. These behaviors were measured via alcohol screening conducted at primary care visits. The study also examined health outcomes at 18 months post-intervention. These health measures were systolic and diastolic blood pressure and blood sugar (i.e., glycohemoglobin [HbA1c] level and ‘controlled HbA1c’ [HbA1c<8%]) at 18-month follow-up for patients with type 2 diabetes. The authors defined a clinically meaningful improvement in blood pressure to be ≥3 mm Hg reduction from baseline at 18 months. All outcomes were measured as part of routine care visits, and thus were derived from participants’ electronic health records. Because this was a naturalistic study using electronic health records only, follow-up time points were approximate (e.g., drinking measured at the 12-month follow-up was as close to 12 months post-intervention as possible).
The researchers used statistical modeling to compare drinking outcomes at 12 months and health outcomes at 18 months between patients who received the brief intervention and those who did not. The researchers used a statistical modeling technique to adjust for variables associated with receiving the brief intervention and the outcomes (drinking and health outcomes). This analytic method allowed the researchers to account for as many alternative explanations of a potential positive effect of brief intervention as possible, thereby increasing confidence that the intervention caused the positive effects on drinking and/or health outcomes.
Participants included individuals with hypertension (n=72,979) and type 2 diabetes (n=19,642). The majority were male (67.5% and 79.0% for the hypertension group and diabetes group respectively). On average, participants with hypertension were 62 years of age while the average age of participants with type 2 diabetes were60. Most participants were non-Hispanic White (70.5% and 52.8%). At baseline about 17% and 15% of participants reported drinking at levels exceeding daily and weekly limits, respectively. Approximately 5% of participants in both samples had an alcohol use disorder diagnosis. Roughly 17% and 15% of participants with hypertension and type 2 diabetes had co-occurring mental health conditions in the prior year, respectively.
Brief interventions reduced alcohol use only for certain subgroups.
All participants drank less alcohol 12 months post-baseline visit regardless of whether they received the brief intervention. However, for those who exceeded only daily drinking limits at baseline, the brief intervention showed greater reduced alcohol use for all 4 outcomes at 12 months. Hypertension patients who exceeded only weekly alcohol limits or those exceeding both daily and weekly alcohol limits drank at similar levels did not benefit from the brief intervention.
Figure 1. All participants drank less compared to their baseline levels regardless of receiving the brief intervention, but differences were seen in changes in drinking levels between those who received the brief intervention and those who didn’t.
Only patients with type 2 diabetes aged 30-44 drank less after receiving the brief intervention.
All other participants with type 2 diabetes had similar alcohol use reductions whether they received the brief intervention or not.
Receiving the brief intervention was associated with reduced blood pressure only among hypertensive patients.
Among patients with hypertension, those who received a brief intervention had an additional decline in blood pressure at 18 months compared with those who did not. Receiving the brief intervention was associated with a 5% greater likelihood of clinically meaningful improvement. The researchers did not observe an association between getting the brief intervention and blood pressure among patients with type 2 diabetes. There was no impact on blood sugar levels for those with diabetes.
The results of the study suggest that an alcohol-focused brief intervention delivered in a primary care setting can impact alcohol use and chronic health conditions among specific types of patients with chronic health conditions.
The researchers found that all participants drank less alcohol 12 months post-baseline visit regardless of if they received the brief intervention or not. Participants with hypertension whose drinking exceeded daily drinking limits at baseline had greater reductions than other groups after receiving the intervention. Hypertension patients who exceeded only weekly limits or those exceeding both daily and weekly limits drank at similar levels as the rest of the sample post-intervention. Similarly, only patients with type 2 diabetes aged 30-44 showed more reductions in alcohol use 1-year post intervention. All other patients with type 2 diabetes showed similar reductions in drinking.
This pattern of results may suggest that the impact of brief interventions varies depending on patients’ characteristics. For example, the finding that only participants whose drinking exceeded daily drinking (but not weekly) limits at baseline drank less after receiving the intervention may suggest that regular heavier drinkers may be more open to the advice and feedback presented during brief interventions. Similarly, the fact that patients with type 2 diabetes saw no changes in alcohol use post intervention suggest that factors like type of chronic disease, disease severity, medication intensity and patient adherence to medications and lifestyle changes may play a role in brief interventions effectiveness. These findings suggest that different approaches, including tailoring to population subgroups or health conditions, may be needed to address unhealthy drinking and related health outcomes among patients with chronic conditions.
Results of this research suggest that a physician administered brief intervention can impact alcohol use and health outcomes among certain types of patients with chronic health conditions. The benefits of the brief intervention to address unhealthy alcohol use for individuals with hypertension and type 2 diabetes varied depending upon individual patient characteristics. Patients with type 2 diabetes aged 30-44 drank less after receiving the brief intervention, whereas all other participants with type 2 diabetes did not drink less alcohol 12 months post–intervention. Participants with hypertension who reported exceeding only daily drinking limits at baseline who received the intervention showed greater reduction on all drinking outcomes 12 months post-intervention. Hypertension patients who exceeded only weekly drinking limits or those exceeding both daily and weekly limits drank at similar levels as the rest of the sample post-intervention. These results suggest that brief interventions targeting alcohol use among primary care patients may not work well for all patients. For example, patients with more severe alcohol use may benefit less from brief interventions. Providers should consider individual patients’ unique demographics/behaviors when deciding to implement a brief intervention or to refer to more intensive treatment. More research is needed to corroborate these findings and test potential interventions.
Chi, F. W., Parthasarathy, S., Palzes, V. A., Kline-Simon, A. H., Weisner, C. M., Satre, D. D., . . . & Sterling, S. A. (2023). Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study. BMJ open, 13(1), e064088. doi: 10.1136/bmjopen-2022-064088
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