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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3078 — Recognition and Management of Alcohol Misuse in OEF/OIF and Other Veteran Cohorts

Greiner GT (VA Puget Sound Health Care System), Harris AH (VA Palo Alto Health Care System), Achtmeyer CE (VA Puget Sound Health Care System), Kivlahan DR (VA Puget Sound Health Care System), Bradley KA (VA Puget Sound Health Care System)

Objectives:
Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) treated in VA have high rates of mental health problems. However, little is known about whether alcohol misuse is recognized and managed similarly in this and other VA cohorts. We compared OEF/OIF with other VA patients on prevalence of alcohol misuse, and documented rates of brief alcohol counseling (BAC) and referral for alcohol misuse.

Methods:
Male VA outpatients were randomly selected for medical record review by OQP’s External Peer Review Program (FY06Qtr4-FY07Qtr3), if < 55 years old and with documented AUDIT-C scores. Consistent with FY08 performance measure, AUDIT-C scores > 5 were considered positive, and BAC was defined as documented alcohol-related advice + feedback linking drinking to health. Referral was defined as documented discussion of referral or scheduled referral for alcohol misuse in or out of VA. Logistic regression modeled relationship between cohort (i.e. OEF/OIF vs. non-OEF/OIF veterans) and (1) prevalence of alcohol misuse, adjusting for age, and (2) documented BAC and referral , adjusting for age and alcohol misuse severity (AUDIT-C score 5-7 and 8-12).

Results:
Of 7,306 eligible outpatients, 414 (6%) were OEF/OIF. Prevalence of alcohol misuse for OEF/OIF and non-OEF/OIF patients was 21% and 17%, respectively. Among outpatients screening positive for alcohol misuse, rates of documented BAC were 14% and 12% for OEF/OIF and non-OEF/OIF, respectively, and rates of documented referral were 30% and 46%, respectively. After adjustment for age, OEF/OIF patients were as likely to screen positive for alcohol misuse as non-OEF/OIF patients (OR=1.18, 95% CI 0.91-1.53). Among outpatients who screened positive, OEF/OIF patients were equally likely to have BAC documented (OR=1.33, CI 0.65-2.75), while odds of documented referral were lower in OEF/OIF patients (OR=0.55, CI 0.32-0.95) in adjusted analyses.

Implications:
Although OEF/OIF outpatients were equally as likely to screen positive for alcohol misuse or have BAC documented, they were less likely to have documented referral for alcohol misuse. Additional research is needed to examine potential reasons for this association (e.g., differences in patient readiness to change).

Impacts:
Future research should seek to identify barriers to referral of OEF/OIF patients with alcohol misuse.


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