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CDA 10-014
Improving Detection and Management of Alcohol Misuse Among VA Inpatients
Lauren M. Broyles PhD RN
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, PA
Funding Period: January 2011 - December 2015

BACKGROUND/RATIONALE:
Improving the identification and management of alcohol misuse is a VA priority. VA recommends using a set of clinical strategies referred to as Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care settings. Brief intervention (BI), a core component of SBIRT, significantly reduces alcohol consumption, morbidity, and healthcare utilization, but its efficacy is not well-established outside of outpatient settings. The inpatient care setting also provides a unique opportunity for early detection and management of alcohol misuse, by nurses, and successful BI implementation models are needed to ensure widespread and sustained integration of SBIRT into clinical practice across the continuum of care.

OBJECTIVE(S):
My overall research objectives for the CDA are to (1) conduct a randomized controlled efficacy trial (RCT) of nurse-delivered alcohol brief intervention in hospitalized patients, (2) evaluate the implementation and clinical effectiveness of a nurse-driven SBIRT delivery model that is integrated across primary and inpatient care settings.

METHODS:
In the first study, we will (1) determine the impact of a nurse-led BI on the alcohol consumption, readiness to change drinking behavior, and adverse consequences of alcohol use in hospitalized hazardous drinkers, and (2) conduct a process evaluation to inform the design and execution of a future, multi-site randomized effectiveness trial of the intervention. In the second study, we will (1) determine the impact of the nurse-driven SBIRT delivery model on rates of BI implementation, (2) conduct a formative evaluation of the nurse-delivered model, and (3) determine the impact of the nurse-delivered model on alcohol-related, healthcare utilization, and cost outcomes among Veterans with unhealthy alcohol use.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
These study aims support clinical care guidelines for improving substance use screening and the provision of motivational counseling for alcohol misuse contained in the VA/DoD SUD Clinical Practice Guidelines and the VA Uni form Mental Health Services Handbook. The results of this study will directly support BI implementation efforts in VA and inform potential nursing practice change for general hospitalized patients and those seen in PACT.

PUBLICATIONS:

Journal Articles

  1. Broyles LM, Wieland ME, Confer AL, DiNardo MM, Kraemer KL, Hanusa BH, Youk AO, Gordon AJ, Sevick MA. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial. Addiction science & clinical practice. 2015 May 13; 10(1):13.
  2. Gabrielian S, Gordon AJ, Gelberg L, Patel B, Manchanda R, Altman L, Andersen RM, Campbell RA, Broyles LM, Conley J, Kertesz S. Primary care medical services for homeless Veterans. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2014 Oct 1; 31(10):10-19.
  3. Broyles LM, Kraemer KL, Kengor C, Gordon AJ. A tailored curriculum of alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for nurses in inpatient settings. Journal of addictions nursing. 2013 Jul 1; 24(3):130-141.
  4. Broyles LM, Conley JW, Harding JD, Gordon AJ. A scoping review of interdisciplinary collaboration in addictions education and training. Journal of addictions nursing. 2013 Jan 1; 24(1):29-36; quiz 37-8.
  5. Broyles LM, Gordon AJ, Rodriguez KL, Hanusa BH, Kengor C, Kraemer KL. Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings. Journal of addictions nursing. 2013 Jan 1; 24(1):8-19.
  6. Broyles LM, Rodriguez KL, Kraemer KL, Sevick MA, Price PA, Gordon AJ. A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center. Addiction science & clinical practice. 2012 May 2; 7(1):7.
  7. Broyles LM, Rosenberger E, Hanusa BH, Kraemer KL, Gordon AJ. Hospitalized patients' acceptability of nurse-delivered screening, brief intervention, and referral to treatment. Alcoholism, clinical and experimental research. 2012 Apr 1; 36(4):725-31.
  8. Broyles LM, Tate JA, Happ MB. Use of augmentative and alternative communication strategies by family members in the intensive care unit. American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses. 2012 Mar 1; 21(2):e21-32.
  9. Childers JW, Broyles LM, Hanusa BH, Kraemer KL, Conigliaro J, Spagnoletti C, McNeil M, Gordon AJ. Teaching the teachers: faculty preparedness and evaluation of a retreat in screening, brief intervention, and referral to treatment. Substance Abuse. 2012 Jan 1; 33(3):272-7.
  10. Broyles LM, Rodriguez KL, Price PA, Bayliss NK, Sevick MA. Overcoming barriers to the recruitment of nurses as participants in health care research. Qualitative Health Research. 2011 Dec 1; 21(12):1705-18.
  11. Broyles LM, Gordon AJ, Sereika SM, Ryan CM, Erlen JA. Predictive Utility of Brief Alcohol Use Disorders Identification Test (AUDIT) for human immunodeficiency virus antiretroviral medication nonadherence. Substance Abuse. 2011 Oct 1; 32(4):252-61.
  12. Broyles LM, Gordon AJ, Sereika SM, Ryan CM, Erlen JA. Do words matter? Incongruent responses to inconsistently worded AUDIT-C alcohol screening instruments. Substance Abuse. 2011 Oct 1; 32(4):202-9.
Journal Other

  1. McCauley HL, Silverman J, Broyles LM, Decker MR, Tancredi DJ, Zelazny S, Miller E. Substance use, intimate partner violence and sexual assault among adolescent and young adult female family planning clients. [Abstract]. Journal of Adolescent Health. 2014 Feb 1; 54(2):S7-S8.
  2. Broyles LM, Binswanger IA, Jenkins JA, Finnell DS, Faseru B, Cavaiola A, Pugatch M, Gordon AJ. Confronting inadvertent stigma and pejorative language in addiction scholarship: a recognition and response. [Editorial]. Substance Abuse. 2014 Jan 1; 35(3):217-21.
  3. Broyles LM, Wieland ME, Confer AL, Youk AO, Gordon AJ. Holes in the pipeline: addressing recruitment challenges for an alcohol brief intervention trial in the acute care setting. [Abstract]. Substance Abuse. 2014 Jan 1; 35(2):208.
  4. Gordon AJ, Broyles LM. A physician-centered approach to addiction identification and treatment misses the opportunity for interdisciplinary solutions. [Editorial]. Substance Abuse. 2014 Jan 1; 35(2):108-9.
  5. Strobbe S, Perhats C, Broyles LM. Expanded roles and responsibilities for nurses in screening, brief intervention, and referral to treatment (SBIRT) for alcohol use. Journal of addictions nursing. 2013 Jul 1; 24(3):203-204.
  6. Broyles LM, Gordon AJ. SBIRT implementation: moving beyond the interdisciplinary rhetoric. [Editorial]. Substance Abuse. 2010 Oct 1; 31(4):221-3.
Book Chapters

  1. Gordon AJ, Gordon JM, Broyles LM. Medical consequences of unhealthy alcohol use. In: Addressing Unhealthy Alcohol Use in Primary Care. Ames, IA: Springer; 2012. Chapter 10. 107-118 p.
Newspaper Article

  1. Broyles LM. 'Power Hour' makes for risky drinking. Pittsburgh Post-Gazette. 2013 Mar 10: Opinion.
Center Product

  1. Broyles LM. Rollout of new Joint Commission measures for alcohol- and tobacco-related inpatient care at VA Pittsburgh Healthcare System. 2014 Oct 15.
  2. Broyles LM. Getting evidence into real-life practice and systems of care: what SBIRT, opioid agonist treatment, and integrated care look like in the VA (Presentation for Advanced Medical Student Fellowship in Alcohol and Other Drug Dependency; Institute for Research, Education and Training in Addictions, Pittsburgh, PA). 2014 Jun 4.
CYBR

  1. Goplerud E, Broyles LM, Robinson E. Keys to implementing and abstracting the substance use measure set [Centers for Medicare and Medicaid Services Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program Webinar]. [Cyberseminar]. 2015 Sep 1.
  2. Gordon AJ, Broyles LM. Writing effective letters of recommendation and promotion for yourself and others [HSR&D Career Development Awardee Series]. [Cyberseminar]. 2015 Jun 9.
Conference Presentations

  1. Broyles LM, Mitchell MA, Blosnich JR, Gordon AJ. Similar but different: alcohol consumption and its consequences among student Veterans and their non-military peers. Paper presented at: University of Pittsburgh School of Nursing The Veteran’s Journey to Achieving Wellness: Successful Reintegration into Civilian Life Conference; 2015 Sep 10; Pittsburgh, PA.
  2. Broyles LM. Getting evidence into real-life practice and systems of care: what SBIRT, opioid agonist treatment, and integrated care look like in the VA. Presented at: Institute for Research, Education, and Training in Addictions Annual Meeting; 2015 Jul 10; Pittsburgh, PA.
  3. Broyles LM, Wakeman SE. From evidence to action: redesigning substance use care in inpatient settings. Paper presented at: American Society of Addiction Medicine Annual Meeting; 2015 Apr 25; Austin, TX.
  4. Dichter M, Wagner C, Borrero S, Montgomery A, Broyles LM. Association between intimate partner violence and homelessness risk, unhealthy alcohol use, and risk of unintended pregnancy. Paper presented at: Futures Without Violence Biennial National Conference on Health and Domestic Violence; 2015 Mar 20; Washington, DC.
  5. Gordon AJ, Binswanger I, Broyles LM, Faseru B, Pugatch M, Saitz R. Getting your article from an idea to a peer-reviewed publication in an addiction journal - a behind the scenes look involving the editorial process, dos and don'ts, journal metrics, and maximizing your article’s impact on addiction science [workshop]. Presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2014 Nov 7; San Francisco, CA.
  6. Mitchell M, Broyles L, Pringle L, Kraemer K, Childers J, Buranosky R, Gordon A. SBIRT education for both the mind and the heart? Assessing changes in medical residents' attitudes to working with drinkers. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2014 Nov 7; San Francisco, CA.
  7. Mitchell MA, Poyrazil S, Broyles LM. Be responsible: hazardous alcohol use and cultural adjustment among US college students abroad in Italy. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2014 Nov 7; San Francisco, CA.
  8. Mitchell MA, Broyles LM, Rodriguez K, True G, Hedayati D, Conley J, Gordon A. Qualitative and participatory-based methods to understand perceived determinants of health among homeless Veterans. Paper presented at: Rita M. McGinley Annual Symposium; 2014 Oct 23; Pittsburgh, PA.
  9. Mitchell MA, Broyles LM, Rodriguez K, True G, Hedayati D, Conley J, Gordon A. Homeless Veterans' opinions of integrated care environments: a photo-narrative study. Poster session presented at: Rita M. McGinley Annual Symposium; 2014 Oct 22; Pittsburgh, PA.
  10. Mitchell MA, Broyles LM, True G, Rodriguez K, Hedayati D, Gordon A. Health care for homeless Veterans: a photo-narrative study to collect patients' perspectives and experiences with integrated primary care environments. Paper presented at: International Nurses Society on Addictions Annual Educational Conference; 2014 Oct 17; Washington, DC.
  11. Finnell DS, Biers A, Seale JP, Savage CL, Swenson C, Broyles LM. Taking the bull by the horns: putting SBI into routine nursing practice. Presented at: International Network on Brief Interventions for Alcohol Problems Annual Conference; 2014 Sep 20; Warsaw, Poland.
  12. Broyles LM, Gordon AJ. Interdisciplinary models in training the next generation of addiction professionals. Presented at: American Society of Addiction Medicine Annual Meeting; 2014 Apr 12; Orlando, FL.
  13. Broyles LM. A nursing primer and toolkit for addressing substance use in the physical rehabilitation setting. Presented at: Association of Rehabilitation Nurses Southwestern Pennsylvania Chapter Meeting; 2014 Mar 25; Pittsburgh, PA.
  14. McCauley HL, Silverman J, Broyles LM, Decker MR, Tancredi DJ, Zelazny S, Miller E. Substance use, intimate partner violence and sexual assault among adolescent and young adult female family planning clients. Paper presented at: Society for Adolescent Health and Medicine Annual Meeting; 2014 Mar 1; Austin, TX.
  15. Broyles LM, Wieland ME, Confer AL, Youk AO, Gordon AJ. Holes in the pipeline: addressing recruitment challenges for an alcohol brief intervention trial in the acute care setting. Poster session presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2013 Nov 8; Bethesda, MD.
  16. Gabrielian S, Gordon AJ, Gelberg L, Patel B, Manchanda R, Altman L, Campbell RA, Broyles LM, Conley J, Kertesz S. Building medical homes for homeless Veterans: a comparison of organizational processes and patient characteristics at three Veterans Affairs facilities. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 6; Boston, MA.
  17. Broyles LM, Conley JW. Scoping reviews: a different lens on the evidence. Presented at: International Nurses Society on Addictions Annual Educational Conference; 2013 Oct 10; Washington, DC.
  18. Broyles LM, Singh M, Rodriguez K, Hayashi S, Monte R, Gordon A. The development of an alcohol brief intervention e-Coach for use by primary care clinicians. Paper presented at: International Network on Brief Interventions for Alcohol Problems Annual Conference; 2013 Sep 19; Rome, Italy.
  19. Nowzari S, Finnell DS, Broyles LM. Nurse provision of alcohol-related interventions in the patient-centered medical home. Poster session presented at: Research Society on Alcoholism Annual Scientific Meeting; 2013 Jun 22; Orlando, FL.
  20. Broyles LM, Gordon AJ, Gabrielian S, Gelberg L, Patel B, Manchanda R, Altman L, Campbell RA, Kertesz S. Building VA medical homes for homeless Veterans. Poster session presented at: VA International Homelessness Research Conference; 2013 Jun 3; Philadelphia, PA.
  21. Broyles LM. Nursing responses to the full spectrum of alcohol use among hospitalized patients. Paper presented at: Addressing Substance Use in the Hospital: Building Bridges to Community Treatment Symposium; 2013 Apr 9; Newark, DE.
  22. Broyles LM. Bridging the great divide: clinical and research partnerships to improve health care for vulnerable Veterans. Presented at: Rita M. McGinley Annual Symposium; 2012 Oct 25; Pittsburgh, PA.
  23. Broyles LM. Screening, brief intervention, and referral to treatment (SBIRT): where’s the nurse? Paper presented at: International Nurses Society on Addictions Annual Educational Conference; 2012 Sep 6; Washington, DC.
  24. Nowzari S, Finnell DS, Broyles LM. Nurse provision of alcohol-related interventions in the patient-centered medical home. Poster session presented at: International Nurses Society on Addictions Annual Educational Conference; 2012 Sep 6; Washington, DC.
  25. Broyles LM. SBIRT research and implementation with medical inpatients. Presented at: American Society of Addiction Medicine Annual Meeting; 2011 Apr 17; Washington, DC.
  26. Broyles LM, Rodriguez KL, Kraemer K, Gordon AJ. Anticipated barriers and facilitators associated with nurse-delivered alcohol SBIRT for hospitalized Veterans. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
  27. Broyles LM, Kraemer KL, Hanusa BH, Luther JL, Gordon AJ. Factors associated with nurses’ readiness to provide alcohol-related care for inpatients. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2010 Nov 6; Bethesda, MD.
  28. Childers JW, Gordon AJ, Kraemer K, McNeil MA, Conigliaro JC, Broyles LM, Spagnoletti CL. Infusing SBIRT into faculty teaching – a model faculty training to acquire SBIRT awareness, knowledge, and skills. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2010 Nov 5; Bethesda, MD.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: Diagnosis, Prevention, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: none
MeSH Terms: none

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