0002 ( CAH) Inpatient and emergency department patients who screen positive for unhealthy alcohol or drug use receive brief motivational enhancement-oriented counseling to encourage reduced hazardous use of alcohol and other drugs and prevent future complications or dependence.

Rationale

Based on the Veterans Health Administration/Department of Defense Substance Use Disorder Guideline, primary care providers should offer patients who drink in unhealthy or dependent ways, use illicit drugs or use prescription drugs for non-medical puposes, a brief intervention may be accomplished in the following general sequence: 1. Give feedback about screening results, relating the risks of negative health effects to the patient's presenting health concerns. 2. Inform the patient about safe consumption limits and offer advice about change. 3. Offer to involve family members in this process to educate them and solicit their input (consent is required). 4. Assess patient’s degree of readiness for change (e.g., “How willing are you to consider reducing your use at this time?”). 5. Negotiate goals and strategies for change. 6. Schedule an initial follow-up appointment in two to four weeks. 7. Monitor changes at follow-up visits by asking patient about use, health effects, and barriers to change. 8. If patient declines referral to specialty evaluation or treatment, continue to encourage reduction or cessation of use and reconsider referral to specialized treatment at subsequent visits. Multiple randomized clinical trials have demonstrated the efficacy of brief interventions by physicians in primary care settings. Training in brief provider intervention has been demonstrated to increase rates of alcohol counseling in primary care when accompanied by real-time cues for screening and facilitative clinic support services (Adams et al., 1998; Buchsbaum et al., 1993).

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Related Performance Requirements

(0 comments) • .0001 Percent of adult inpatients who receive a brief intervention for unhealthy or dependent alcohol use or substance use (including non-medical use of prescription medications). Numerator: Eligible inpatients with medical record documentation of brief counseling for unhealthy alcohol and/or drug use. Denominator: Adult inpatients. Scoring: numerator divided by the denominator, multiplied by 100 to convert ot a percent. Rationale: Brief intervention is a separate procedure from screening. Although the proportion of adults patients who receive a brief intervention depends on the prevalence of unhealthy and dependent alcohol and drug use (including prescription medication misuse) in the base population, medical records documentation of brief interventions for substance use problems ought not be rare phenomena (~7.5% in general, non-psychiatric inpatients, according to an NIAAA epidemiologic survey)

(0 comments) • .0002 Percent of adult emergency department patients who receive a brief intervention for unhealthy or dependent alcohol use or substance use (including non-medical use of prescription medications). Numerator: Eligible adult emergency department patients with medical record documentation of brief counseling for unhealthy alcohol and/or drug use. Denominator: Adult emergency department patients. Scoring: numerator divided by the denominator, multiplied by 100 to convert to a percent.

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