Are people who consume alcohol—but who aren’t dependent on it—drinking to levels that can harm their health? Could the risk be effectively detected and addressed in primary care? Kathy Bradley has been exploring these questions since the late 1980s, when researchers recognized that risky drinking accounts for more illness and death than alcohol addiction, which is much less common.
A general internist, Dr. Bradley concentrates on identifying and addressing unhealthy alcohol use in primary care. Research shows that even a short discussion with a health care provider can help patients reduce risky drinking. In 5 to 15 minutes, a counseling intervention typically advises drinking below recommended limits or abstaining, connects drinking to the patient’s health concerns, and helps the patient set change goals. The recent National Commission on Prevention Priorities ranked alcohol screening and brief alcohol counseling the third-highest priority among prevention recommendations for adults.
While at the Veterans Affairs (VA) Puget Sound Health Care System, Dr. Bradley discovered ways to more efficiently identify unhealthy alcohol use. Her team validated the “AUDIT-C” three-item alcohol screen and a single-question screen in VA patients as well as non-VA patient populations. They also linked high AUDIT-C scores with adverse health outcomes, including decreased medication adherence and increases in fractures and trauma; hospitalizations for liver disease, gastrointestinal bleeding and pancreatitis; surgical complications and post-op health care utilization; and mortality. An ongoing VA study is evaluating whether changes in AUDIT-C scores are associated with changes in health outcomes. If so, AUDIT-C scores could be used as a “vital sign” to monitor drinking.
Dr. Bradley was instrumental in helping implement alcohol screening and brief alcohol counseling at more than 900 VA sites—and in developing the VA's national performance measures. Using performance measures and decision support in an electronic health record (EHR), yearly alcohol screening rates in the VA have been high since 2007. Her team also developed and tested an EHR-based clinical reminder that provides decision support for brief alcohol counseling, as well as performance measures for counseling. Together, the EHR tools and the performance measures recently resulted in high rates of alcohol counseling.
Currently, Dr. Bradley is evaluating performance measures of brief alcohol counseling. She recently turned her attention to management of alcohol use disorders in primary care settings, as well as identifying and addressing drug use disorders with proactive outreach. She is leading the National Institute of Health's National Institute on Alcohol Abuse and Alcoholism Study on Collaborative Care for Primary Care Patients with unhealthy drinking: "Considering Healthier Drinking Options in Collaborative Care" (CHOICE) trial, which has finished enrollment and will be completed in October 2015. She and her clinical partners are also funded by the Agency for Health Research and Quality to implement alcohol screening, brief alcohol counseling, and shared decision-making for alcohol use disorders in a sustainable manner at all 25 primary care clinics within Group Health. In addition, she has ongoing research developing a patient decision aid for shared decision-making for alcohol use disorders, and with her clinical partners, has obtained a Group Health Partnership for Innovation grant to test proactive outreach from primary care teams to patients with alcohol or drug use disorders.
Alcohol and drug misuse
Alcohol and drug use disorders
Physician decision support; eHealth
Implementation research; quality measurement
Alcohol and drug screening; brief alcohol interventions
Screening and brief intervention; mental health quality measurement
Primary care management of alcohol misuse
Chavez LJ, Liu CF, Tefft N, Hebert PL, Devine B, Bradley KA. The association between unhealthy alcohol use and acute care expenditures in the 30 days following hospital discharge among older Veterans Affairs patients with a medical condition. J Behav Health Serv Res. 2016 Sep 1 [Epub ahead of print]. PubMed
McClure JB, Anderson ML, Bradley K, An LC, Catz SL. Evaluating an adaptive and interactive mHealth smoking cessation and medication adherence program: a randomized pilot feasibility study. JMIR Mhealth Uhealth. 2016 Aug 3;4(3):e94. doi: 10.2196/mhealth.6002. PubMed
Grossbard J, Malte CA, Lapham G, Pagulayan K, Turner AP, Rubinsky AD, Bradley KA, Saxon AJ, Hawkins EJ. Prevalence of alcohol misuse and follow-up care in a national sample of OEF/OIF VA patients with and without TBI. Psychiatr Serv. 2016 Aug 1:appips201500290. [Epub ahead of print]. PubMed
Bradley KA, Rubinsky AD, Lapham GT, Berger D, Bryson C, Achtmeyer C, Hawkins EJ, Chavez LJ, Williams EC, Kivlahan DR. Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs (VA) population. Addiction. 2016 Jun 27. doi: 10.1111/add.13505. [Epub ahead of print]. PubMed
Drs. Katharine Bradley and Gwen Lapham studied drinking habits and hospital readmission. They found that underlying social determinants might be the connection.
Read it in Healthy Findings.
GHRI researchers are partnering with leaders in Behavioral Health Support Services at Group Health to revolutionize care for unhealthy alcohol use.
Read about it in News and Events.
New York Times, May 14, 2014