Journal of General Internal Medicine

, Volume 25, Supplement 1, pp 11–17 | Cite as

Use of an Electronic Clinical Reminder for Brief Alcohol Counseling is Associated with Resolution of Unhealthy Alcohol Use at Follow-Up Screening

  • Emily C. WilliamsEmail author
  • Gwen Lapham
  • Carol E. Achtmeyer
  • Bryan Volpp
  • Daniel R. Kivlahan
  • Katharine A. Bradley
Original Article



Brief alcohol counseling is a foremost US prevention priority, but no health-care system has implemented it into routine care. This study evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling (“reminder”). The specific aims were to (1) determine the prevalence of use of the reminder and (2) evaluate whether use of the reminder was associated with resolution of unhealthy alcohol use at follow-up screening.


The reminder was implemented in February 2004 in eight VA clinics where providers routinely used clinical reminders. Patients eligible for this retrospective cohort study screened positive on the AUDIT-C alcohol screening questionnaire (February 2004–April 2006) and had a repeat AUDIT-C during the 1–36 months of follow-up (mean 14.5). Use of the alcohol counseling clinical reminder was measured from secondary electronic data. Resolution of unhealthy alcohol use was defined as screening negative at follow-up with a ≥2-point reduction in AUDIT-C scores. Logistic regression was used to identify adjusted proportions of patients who resolved unhealthy alcohol use among those with and without reminder use.


Among 4,198 participants who screened positive for unhealthy alcohol use, 71% had use of the alcohol counseling clinical reminder documented in their medical records. Adjusted proportions of patients who resolved unhealthy alcohol use were 31% (95% CI 30–33%) and 28% (95% CI 25–30%), respectively, for patients with and without reminder use (p-value = 0.031).


The brief alcohol counseling clinical reminder was used for a majority of patients with unhealthy alcohol use and associated with a moderate decrease in drinking at follow-up.


alcohol drinking brief alcohol counseling brief intervention clinical reminder implementation 



The clinical reminder evaluated in this study was developed with funding from The Robert Wood Johnson Foundation’s Generalist Physicians Faculty Scholars Program. This study was supported by the Veteran’s Affairs (VA) Substance Use Disorders Quality Enhancement Research Initiative (SUD QuERI) and the VA’s Northwest Center of Excellence for Health Services Research and Development. The authors gratefully acknowledge Haili Sun, PhD, for data extraction and management and Thomas M. Wickizer, PhD, Thomas D. Koepsell, MD, MPH, and Patrick J. Heagerty, PhD, for careful review of and helpful comments on the analytical plan.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Emily C. Williams
    • 1
    • 5
    Email author
  • Gwen Lapham
    • 1
    • 5
  • Carol E. Achtmeyer
    • 1
    • 2
  • Bryan Volpp
    • 6
  • Daniel R. Kivlahan
    • 1
    • 4
  • Katharine A. Bradley
    • 1
    • 2
    • 3
  1. 1.Northwest Center of Excellence for Health Services Research & DevelopmentVeterans Affairs (VA) Puget Sound Health Care SystemSeattleUSA
  2. 2.Primary and Specialty Medical Care ServiceVeterans Affairs (VA) Puget Sound Health Care SystemSeattleUSA
  3. 3.Departments of MedicineUniversity of WashingtonSeattleUSA
  4. 4.Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  5. 5.Health ServicesUniversity of WashingtonSeattleUSA
  6. 6.VA Northern California Healthcare SystemMartinezUSA

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