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Study Compares Treatment for Drinking Problems in Primary Care vs. Referral-Based Management in VA


Among patients seen in primary care settings, it is estimated that 15-20% of men and 5-10% of women have a drinking problem, and studies have shown that many drinking problems can be effectively treated within primary care settings. Moreover, primary care treatment is considered to be more cost-effective than specialty care treatment. Relying upon the Chronic Care Model, this study identified organizational factors that distinguish primary care (PC) practices using PC-based approaches versus referral-based management of Veterans with drinking problems in the VA healthcare system. Investigators assessed data from a national survey of 218 VA primary care practices (administered between 8/99 and 2/00) to determine primary care practices’ usual management of patients with drinking problems and other organizational features. Investigators also analyzed data on system characteristics (e.g., facility size and type), as well as the existence and characteristics of specialty treatment programs.

Findings show that PC- and referral-based practices did not differ on the sufficiency of their structural resources, physician staffing, or on the availability of specialty services. However, PC-based practices were found to take more responsibility for managing Veterans’ chronic conditions and had more staff for decision support activities. The authors suggest that the use of Chronic Care Model concepts and organizational theory can help guide and prioritize multi-level, multi-faceted, multi-step efforts to implement and assess primary care-based management approaches.

PubMed Logo Schutte K, Yano E, Kilbourne A, Wickrama B, Kirchner J, and Humphreys K. Organizational contexts of primary care approaches for managing problem drinking. Journal of Substance Abuse Treatment June 2009;36(4):435-445.

This study was funded by HSR&D and VA/HSR&D’s Substance Use Disorders Quality Enhancement Research Initiative (SUD-QUERI). Drs. Schutte and Humphreys are part of HSR&D’s Center for Health Care Evaluation: Improving Clinical Decision-Making and Treatment Effectiveness in Palo Alto, and Dr. Humphreys also is part of SUD-QUERI.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.