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Alcohol check-in shows broad benefits

A Kaiser Permanente doctor’s thoughtful questions can help patients with an alcohol problem — and hypertension too.

The Alcohol as a Vital Sign check-in has become routine in the 9 years since it was added to Kaiser Permanente Northern California adult primary care visits. Medical assistants ask patients about heavy drinking in the previous 3 months. When the patient goes in to see the doctor, those who screen positive for unhealthy drinking have a brief intervention — a conversation in which the clinician uses motivational interviewing techniques to encourage a change in behavior.

A study from the Division of Research (DOR) shows the doctor’s chat not only helps reduce unhealthy alcohol use, but also blood pressure in patients with hypertension.

Researcher Stacy Sterling, DrPH, MSW, is excited to see the intervention make a difference in other health conditions. “This is additional confirmation that even small reductions in drinking result in important improvements in health outcomes, and on a population level that can be very powerful,” said Sterling, co-director of DOR’s Center for Addiction and Mental Health Research.

Unhealthy drinking is considered more than 3 drinks on any day or 7 drinks per week for women and men aged 66 and older and more than 4 drinks on any day or 14 drinks per week for men aged 18 to 65.

For Kaiser Permanente primary care practitioners, the alcohol brief intervention is one more tool they can use to address lifestyle factors in chronic illness, said Sameer Awsare, MD, associate executive director of The Permanente Medical Group. “Making lifestyle changes to control high blood pressure — such as reducing alcohol intake — is an important addition to the medications we can prescribe for our hypertension patients,” he said.

Research supports brief intervention

In the study published last winter in the journal BMJ Open, Sterling and her team looked at records for 440,882 patients who screened positive for unhealthy drinking, and measured health outcomes 18 months later. The intervention patients had an additional reduction of .06 drinks per day or .3 drinks per week 12 months later.

The hypertension patients also had a 5% greater chance of having their diastolic blood pressure (the bottom number on a blood pressure reading) drop by up to 3 points, which is a clinically meaningful reduction linked to lower risk of being diagnosed with, or dying from, cardiovascular disease. They didn’t see an improvement for patients with type 2 diabetes.

“The reduction in blood pressure was modest but significant,” said lead author Felicia Chi, MPH, senior data consultant at Kaiser Permanente Northern California’s Division of Research. “The difference is particularly important for health systems looking for ways to address these chronic conditions and behaviors.”

Sterling said the study team will continue to follow real-world use of brief intervention for additional insights. “This is a very rich data set, and we are looking at brief intervention’s potential impact on a variety of different health conditions,” she said.

“While alcohol use is the subject, we always intended for this workflow to be a tool for clinicians to address a whole range of health conditions,” Sterling continued. “Brief intervention on alcohol should be part of an overall conversation about health, destigmatizing behaviors traditionally seen as ‘bad’ to focus on positive, healthy well-being.”


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