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Impact Of Vital Signs Screening & Clinician Prompting On Alcohol And Tobacco Screening And Intervention Rates: A Pre-post Intervention Comparison

J. Seale, S. Shellenberger, M. Velasquez, J. Boltri, I. Okosun, Monique Guyinn, D. Vinson, Monica Cornelius, J. A. Johnson
Published 2010 · Medicine

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BackgroundThough screening and intervention for alcohol and tobacco misuse are effective, primary care screening and intervention rates remain low. Previous studies have increased intervention rates using vital signs screening for tobacco misuse and clinician prompts for screen-positive patients for both alcohol and tobacco misuse. This pilot study's aims were: (1) To determine the feasibility of combined vital signs screening for tobacco and alcohol misuse, (2) To assess the impact of vital signs screening on alcohol and tobacco screening and intervention rates, and (3) To assess the additional impact of tobacco assessment prompts on intervention rates.MethodsIn five outpatient practices, nurses measuring vital signs were trained to routinely ask a single tobacco question, a prescreening question that identified current drinkers, and the single alcohol screening question for current drinkers. After 4-8 weeks, clinicians were trained in tobacco intervention and nurses were trained to give tobacco abusers a tobacco questionnaire which also served as a clinician intervention prompt. Screening and intervention rates were measured using patient exit interviews (n = 622) at baseline, during the "screening only" period, and during the tobacco prompting phase. Changes in screening and intervention rates were compared using chi square analyses and test of linear trends. Clinic staff were interviewed regarding patient and staff acceptability. Logistic regression was used to evaluate the impact of nurse screening on clinician intervention, the impact of alcohol intervention on concurrent tobacco intervention, and the impact of tobacco intervention on concurrent alcohol intervention.ResultsAlcohol and tobacco screening rates and alcohol intervention rates increased after implementing vital signs screening (p < .05). During the tobacco prompting phase, clinician intervention rates increased significantly for both alcohol (12.4%, p < .001) and tobacco (47.4%, p = .042). Screening by nurses was associated with clinician advice to reduce alcohol use (OR 13.1; 95% CI 6.2-27.6) and tobacco use (OR 2.6; 95% CI 1.3-5.2). Acceptability was high with nurses and patients.ConclusionsVital signs screening can be incorporated in primary care and increases alcohol screening and intervention rates. Tobacco assessment prompts increase both alcohol and tobacco interventions. These simple interventions show promise for dissemination in primary care settings.
This paper references
The efficacy of a brief alcohol intervention combined with %CDT feedback in patients being treated for type 2 diabetes and/or hypertension.
M. Fleming (2004)
Descriptive epidemiology and risk factors for head and neck cancer.
E. Sturgis (2004)
Can distance learning improve smoking cessation advice in family practice? A randomized trial
J. Young (2002)
Clinician Screening and Treatment of Alcohol, Drug, and Mental Problems in Primary Care: Results From Healthcare for Communities
M. Edlund (2004)
Smoking cessation in primary care: a clinical effectiveness trial of two simple interventions.
Catherine E Milch (2004)
Cessation of alcohol drinking and risk of cancer of the oral cavity and pharynx
S. Franceschi (2000)
Validation of a single screening question for problem drinking.
R. Williams (2001)
BMC Family Practice
G. Elwyn (2005)
Treating tobacco use and dependence. Clinical practice guidelines.
M. Fiore (2000)
Screening for alcohol misuse.
J. Huntley (2002)
Harmful Alcohol Use
G. Gmel (2003)
Increasing the Screening and Counseling of Adolescents for Risky Health Behaviors: A Primary Care Intervention
E. Ozer (2005)
Training primary care clinicians in maintenance care for moderated alcohol use
P. Friedmann (2007)
Labeling smokers' charts with a "smoker" sticker: results of a randomized controlled trial among private practitioners.
J. Etter (2000)
Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies
R. Peto (2000)
Smoking status as a vital sign
Jasjit S. Ahluwalia (2007)
Tailored interventions for multiple risk behaviors.
V. Strecher (2002)
World Health Organization Global Status Report on Alcohol 2004
R Saitz
Smoking status as the new vital sign: effect on assessment and intervention in patients who smoke.
M. Fiore (1995)
Initial Steps Taken by Nine Primary Care Practices to Implement Alcohol Screening Guidelines with Hypertensive Patients
P. Miller (2006)
LaVecchia C: Cessation of alcohol drinking and risk of cancer of the oral cavity and pharynx
S Franceschi (2000)
Effectiveness of a clinic-based strategy for implementing the AHRQ Smoking Cessation Guideline in primary care.
D. Katz (2002)
Lung cancer risk reduction after smoking cessation: observations from a prospective cohort of women.
J. Ebbert (2003)
Alcohol counseling: physicians will do it.
A. Adams (1998)
Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services
Effect of training on general practitioners' use of a brief intervention for excessive drinkers
R. Richmond (1998)
Provider feedback improves adherence with AHCPR Smoking Cessation Guideline.
J. Andrews (2001)
Primary care: is there enough time for prevention?
K. S. Yarnall (2003)
A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a World Health Organization collaborative study.
M. Funk (2005)
Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists.
P. Friedmann (2000)
Health Behavior Change: A Guide for Practitioners
S. Rollnick (1999)
Health Behavior Change: A Guide for Practitioners
S. Moore (2005)
Measuring Alcohol Consumption: Psychosocial and Biochemical Methods
R. Litten (1992)
Counseling to Prevent Tobacco Use U . S . Preventive Services Task Force : Screening for Alcohol Misuse
RL Brown
National Institute on Alcohol Abuse and Alcoholism: 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions
Screening for problem drinking: does a single question work?
N. Taj (1998)
Jané-Llopis E: How can we increase the involvement of primary health care in the treatment of tobacco dependence? A metaanalysis
J Anderson (2004)
Helping Patients Who Drink Too Much
N. Skolnik (2005)
Ethnic and gender differences in lifestyle risk factors in a bi-ethnic primary care sample: prevalence and clinical implications.
J. Seale (2006)
Delivery of Clinical Preventive Services in Family Medicine Offices
B. Crabtree (2005)
Timeline Follow-Back A Technique for Assessing Self-Reported Alcohol Consumption
L. Sobell (1992)
Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis.
P. Anderson (2004)
Annual smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 1997-2001.
J. Gerberding (2005)
CD000165, Review. Update in: Cochrane Database Syst Rev
C Silagy (2001)
SPSS 14.0 Software and Manual
Screening for alcohol problems in primary care: a systematic review.
D. Fiellin (2000)
Prevalence of tobacco and alcohol use disorders in Polish primary care settings.
L. Manwell (2002)
Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations.
A. Moyer (2002)
History of alcohol or drug problems, current use of alcohol or marijuana, and success in quitting smoking.
G. Humfleet (1999)
Diagnostic Interview Schedule for DSM-IV (DIS-IV)
D. Segal (2010)
A controlled trial of educational strategies to teach medical students brief intervention skills for alcohol problems.
A. Roche (1997)
Effects of alcohol and tobacco on aerodigestive cancer risks: a meta-regression analysis. Cancer Causes Control
A Zeka (2003)
Annual smokingattributable mortality, years of potential life lost, and productivity losses-United States
Timeline follow-back: a technique for assessing selfreported alcohol consumption. Measuring alcohol consumption: psychosocial and biochemical methods Totowa
Lc Sobell (1992)
How can we increase the involvement of primary health care in the treatment of tobacco dependence? A metaanalysis
J Anderson (2004)
Project MAINSTREAM's first fellowship cohort: Pilot test of a national dissemination model to enhance substance abuse curriculum at health professions schools
R. Brown (2006)
2001 - 2002 National Epidemiologic Survey on Alcohol and Related Conditions
EM Sturgis
Preventive Services Task Force: Screening for Alcohol Misuse
Nicotine replacement for smoking cessation Health Behavior Change: A Guide for Practitioners London
C Silagy (1999)
Nicotine replacement for smoking cessation
C Silagy (2004)
Timeline follow-back: a technique for assessing selfreported alcohol consumption. Measuring alcohol consumption: psychosocial and biochemical methods Totowa, NJ: Humana PressLitten RZ
LC Sobell (1992)
Counseling to prevent tobacco use
T. Kottke (1989)
Preventive Services Task Force: Counseling to Prevent Tobacco Use
Triggering anti-smoking advice by GPs: mode of action of an intervention stimulating smoking cessation advice by GPs.
A. McEwen (2006)
Primary care validation of a single screening question for drinkers.
J. Seale (2006)
Response to nicotine dependence treatment in smokers with current and past alcohol problems
J. Taylor Hays (1999)
Training medical providers to conduct alcohol screening and brief interventions.
T. Babor (2004)
A Practice Change Model for Quality Improvement in Primary Care Practice
D. Cohen (2004)
Tobacco, alcohol, and drug use in a primary care sample: 90-day prevalence and associated factors.
L. Manwell (1998)
Clinical practice. Unhealthy alcohol use.
R. Saitz (2005)
How can we increase the involvement of primary health care in the treatment of tobacco dependence? A meta-analysis.
P. Anderson (2004)
Screening and intervention for alcohol problems
P. Friedmann (2000)
Stopping drinking and risk of oesophageal cancer
K. Cheng (1995)
Physician advice for smoking cessation.
T. Lancaster (2004)
Demissie K: Missing paternal demographics: A novel indicator for identifying high risk population of adverse pregnancy outcomes. BMC Pregnancy Childbirth 2004, 4:21. Pre-publication history The pre-publication history for this paper can be accessed here:
World Health Organization Global Status Report on Alcohol
Using simulated patients in education about alcohol misuse.
J. Eagles (2001)
Effects of alcohol and tobacco on aerodigestive cancer risks: a meta-regression analysis
A. Zeka (2004)
Addressing Alcohol Problems in Primary Care: A Cluster Randomized, Controlled Trial of a Systems Intervention: The Screening and Intervention in Primary Care (SIP) Study
R. Saitz (2003)
The cumulative risk of lung cancer among current, ex- and never-smokers in European men
A. Crispo (2004)
CDC): Annual smokingattributable mortality, years of potential life lost, and productivity losses–United States
Training health professionals in smoking cessation.
T. Lancaster (2000)
Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 1997–2001
L. Tanoue (2007)
A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a World Health Organization collaborative study.
R. Fleming (2010)
Implementing alcohol screening and intervention in a family medicine residency clinic.
J. Seale (2005)
Drinking as a risk factor for sustained smoking.
D. Dawson (2000)
Efficacy of resident training in smoking cessation: a randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients.
J. Cornuz (2002)
Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations.
T. Babor (2006)
Improving family physicians' use of evidence-based smoking cessation strategies: a cluster randomization trial.
J. Young (2002)
Use of the vital sign stamp as a systematic screening tool to promote smoking cessation.
M. Piper (2003)

This paper is referenced by
Evaluation of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for Social Workers
Jennifer M. Putney (2017)
The Effects of Combining Web-Based eHealth With Telephone Nurse Case Management for Pediatric Asthma Control: A Randomized Controlled Trial
D. Gustafson (2012)
Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers
R. Murray (2019)
Web-Based SBIRT Skills Training for Health Professional Students and Primary Care Providers
T. Bradley Tanner (2012)
Improved documentation and care planning with an asthma-specific history and physical.
Andrew Beck (2012)
Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study
Andrew Quanbeck (2014)
Integrating Prevention and Screening for Lung Cancer into Clinical Practice
W. Hocking (2013)
Informal carers' support needs when caring for a person with dementia - A scoping literature review.
Trine Holt Clemmensen (2020)
Potential Roles for New Communication Technologies in Treatment of Addiction
K. Johnson (2011)
Smoking cessation and substance use modification in cardiovascular disease
G. Dalack (2012)
Screening for at-risk alcohol use and drug use in an emergency department: integration of screening questions into electronic triage forms achieves high screening rates.
J. A. Johnson (2013)
Pilot Test of a Computer-Based System to Help Family Caregivers of Dementia Patients.
D. Gustafson (2019)
Alcohol consumption and risky drinking patterns in Malaysia: findings from NHMS 2011.
M. L. A. Mutalip (2014)
Evaluation of two multi-component interventions for integrating smoking cessation treatments into routine primary care practice: a cluster randomized trial
S. Papadakis (2011)
Primary Care Residents Lack Comfort and Experience with Alcohol Screening and Brief Intervention: A Multi-Site Survey
K. B. Le (2015)
Eligibility for interventions, co-occurrence and risk factors for unhealthy behaviours in patients consulting for routine primary care: results from the Pre-Empt study
E. Randell (2015)
Smoking Cessation: A Current Update from FCTC Article 14 Adoption in Thailand
Thayaroch Tipyawong (2015)
Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings.
S. Ornstein (2013)
Implementation Barriers and Facilitators to Screening, Brief Intervention, Referral to Treatment (SBIRT) in Federally Qualified Health Centers (FQHCs)
Tracy McPherson (2017)
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