3069 — Factors Impacting Women's Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans

Cucciare MA, Central Arkansas Veterans Affairs Healthcare System; Lewis ET, VA Palo Alto Healthcare System; Hoggatt KJ, VA Greater Los Angeles Healthcare System; Bean-Mayberry B, VA Greater Los Angeles Healthcare System; Timko C, VA Palo Alto Healthcare System; Durazo E, VA Palo Alto Healthcare System; Jamison AL, VA Palo Alto Healthcare System; Frayne S, VA Palo Alto Healthcare System;

Objectives:
One in five women Veterans screen positive for alcohol misuse. Women may be less likely to disclose alcohol use to a primary care provider (PCP) than men, resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may impact women Veterans' willingness to disclose alcohol use to a PCP.

Methods:
Between October 2012 and May 2013, in-depth interviews were conducted with 30 women Veterans at two Department of Veterans Affairs (VA) medical facilities. Qualitative data analyses identified common themes representing factors that influence women's decisions about disclosure of alcohol use to PCPs.

Results:
Nine themes were endorsed by women Veterans as influencing their willingness to disclose alcohol use to their PCP. Eight themes were identified a priori - support from others; negative emotions such as concerns about being judged or labeled an "alcoholic"; self-appraisal of drinking behavior; health concerns associated with drinking; and other life-related consequences of alcohol misuse; provider behaviors perceived as discouraging or encouraging disclosure of alcohol misuse; and clinic-related factors. The perceived quality of the patient-provider relationship also emerged from the qualitative interviews as impacting disclosure.

Implications:
Our findings demonstrate the importance of social relationships, comfort with one's provider, and education on the potential harms (especially health-related) associated with alcohol in encouraging disclosure of alcohol use in this population. Our results also support VA national healthcare efforts including the provision of brief alcohol counseling and the use of primary care clinics specializing in the care of women Veterans.

Impacts:
Our findings reinforce VA's efforts to make the delivery of high-quality patient-centered health care (including SUD care) to women Veterans a top priority including the development of primary care clinics within VA medical facilities that specialize in the care of women Veterans and designated women's health providers who are preferentially assigned women patients. Our findings also have implications for encouraging the disclosure of alcohol misuse among women in VA and in non-VA healthcare settings including those with limited resources.