Screening patients for high-risk behaviors such as unhealthy alcohol use is a foundation of good preventive care. But how often and in what form does such screening work best? GHRI Research Associate Gwen Lapham is on a mission to find out.
Dr. Lapham joined the Institute in 2013 after six years as the senior project director and data analyst for the Alcohol Misuse Workgroup at the Veterans Affairs (VA) Puget Sound Health Care System, Department of Health Services Research & Development. Working with her longtime VA mentor Katherine Bradley, MD, MPH, now a GHRI senior investigator, Dr. Lapham is shedding light on practical strategies to make screening for alcohol misuse more efficient and effective.
Most patients screen negative for unhealthy alcohol use during in-person assessments—and until recently, little was known about the optimal intervals and methods for repeat screening of these patients. But by delving into the VA’s rich data on routine alcohol screening, Dr. Lapham and colleagues are starting to identify the sweet spot—the point at which the value gained from repeat screening outweighs the resources necessary to conduct screening and follow-up on positive screens. Publishing in Medical Care in October 2013, they found that extending the screening interval was appropriate for certain low-risk veterans.
Previously, Dr. Lapham demonstrated that the VA’s effort to implement brief interventions for unhealthy alcohol use in more than 900 clinics nationwide led to increases in provider-documented brief interventions. She also found that recently returned Veterans need information on the importance of recommended drinking limits and may be more willing to honestly report their alcohol use when it’s not documented in their medical record.
Moving forward, Dr. Lapham is pursuing work to implement evidence-based and patient-centered care for unhealthy alcohol use in other settings. A recipient of the University of Washington (UW) School of Public Health 2012 Outstanding Graduate Student Award, she currently serves as a member of the Research Society on Alcoholism and is part of the UW’s Health Services Professional Development Group.
Unhealthy alcohol use
Alcohol use disorders
Implementation research; quality measurement
Screening and brief intervention; mental health quality measurement
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 Nov;111(11):1975-1984. doi: 10.1111/add.13505. Epub 2016 Aug 2. 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
Chavez LJ, Williams EC, Lapham GT, Rubinsky AD, Kivlahan DR, Bradley KA. Changes in patient-reported alcohol-related advice following veterans health administration implementation of brief alcohol interventions. J Stud Alcohol Drugs. 2016 May;77(3):500-8. PubMed
Bradley KA, Lapham GT. Is it time for a more ambitious research agenda for decreasing alcohol-related harm among young adults? Addiction. 2016 Mar 6. doi: 10.1111/add.13235. [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.