Alcohol Counseling Reflects Higher Quality of Primary Care

Background  Some primary care physicians do not conduct alcohol screening because they assume their patients do not want to discuss alcohol use. Objectives  To assess whether (1) alcohol counseling can improve patient-perceived quality of primary care, and (2) higher quality of primary care is associated with subsequent decreased alcohol consumption. Design  A prospective cohort study. Subjects  Two hundred eighty-eight patients in an academic primary care practice who had unhealthy alcohol use. Measurements  The primary outcome was quality of care received measured with the communication, whole-person knowledge, and trust scales of the Primary Care Assessment Survey (PCAS)]. The secondary outcome was drinking risky amounts in the past 30 days (measured with the Timeline Followback method). Results  Alcohol counseling was significantly associated with higher quality of primary care in the areas of communication (adjusted mean PCAS scale scores: 85 vs. 76) and whole-person knowledge (67 vs. 59). The quality of primary care was not associated with drinking risky amounts 6 months later. Conclusions  Although quality of primary care may not necessarily affect drinking, brief counseling for unhealthy alcohol use may enhance the quality of primary care. Results of this study were presented at the following meetings: the annual national meeting of the Society of General Internal Medicine, Chicago, May 2004 and the annual national meeting of the Research Society on Alcoholism, Vancouver, Canada, June 2004. This study was funded by a grant from the Robert Wood Johnson Foundation (grant 031489). Dr. Samet received support from the National Institute on Alcohol Abuse and Alcoholism (K24-AA015674).