Journal of General Internal Medicine

, Volume 34, Issue 2, pp 256–263 | Cite as

Rates and Impact of Adherence to Recommended Care for Unhealthy Alcohol Use

  • Kimberly A. HepnerEmail author
  • Susan M. Paddock
  • Katherine E. Watkins
  • Katherine J. Hoggatt
  • Lisa V. Rubenstein
  • Andy Bogart
  • Praise O. Iyiewuare
  • Susan C. Rosenbluth
  • Harold Alan Pincus
Original Research



Unhealthy alcohol use is a major worldwide health problem. Yet few studies have assessed provider adherence to the alcohol-related care recommended in clinical practice guidelines, nor links between adherence to recommended care and outcomes.


To describe quality of care for unhealthy alcohol use and its impacts on drinking behavior

Research Design

Prospective observational cohort study of quality of alcohol care for the population of patients screening positive for unhealthy alcohol use in a large Veterans Affairs health system.


A total of 719 patients who screened positive for unhealthy alcohol use at one of 11 primary care practices and who completed baseline and 6-month telephone interviews.

Main Measures

Using administrative encounter and medical record data, we assessed three composite and 21 individual process-based measures of care delivered across primary and specialty care settings. We assessed self-reported daily alcohol use using telephone interviews at baseline and 6-month follow-up.

Key Results

The median proportion of patients who received recommended care across measures was 32.8% (range < 1% for initiating pharmacotherapy to 93% for depression screening). There was negligible change in drinking for the study population between baseline and 6 months. In covariate-adjusted analyses, no composites were significantly associated with changes in heavy drinking days or drinks per week, and just one of nine individual measures tested was significantly associated. In a subsample of patients drinking above recommended weekly limits prior to screening, two of nine individual measures were significantly associated.


This study shows wide variability in receipt of recommended care for unhealthy alcohol use. Receipt of recommended interventions for reducing drinking was frequently not associated with decreased drinking. Results suggest deficits in provision of comprehensive alcohol care and in understanding how to improve population-based drinking outcomes.


alcoholism and addictive behavior primary care quality assessment substance abuse veterans 



We thank the VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy and Lisa Altman, MD, for their collaboration and organizational support of this research. Further, we are grateful for the extensive contribution of Daniel Kivlahan, PhD, to this study and for his critiques on earlier versions of this manuscript. Portions of this paper were presented at the 2017 Addiction Health Services Research (AHSR) conference, Madison, WI; the 2017 International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA) conference, New York, NY; and the 2017 Research Society on Alcoholism (RSA) conference, Denver, CO.

Funding Information

This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R01AA019440). Dr. Hoggatt was funded through a Department of Veterans Affairs, Veterans Health Administration (VA) Health Services Research & Development/Quality Enhancement Research Initiative (HSR&D/QUERI) Career Development Award (CDA 11-261) at the VA Greater Los Angeles Healthcare System.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The views expressed within are solely those of the authors, and do not necessarily represent the views of the Department of Veterans Affairs or of the United States government.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Kimberly A. Hepner
    • 1
    Email author
  • Susan M. Paddock
    • 1
  • Katherine E. Watkins
    • 1
  • Katherine J. Hoggatt
    • 2
    • 3
  • Lisa V. Rubenstein
    • 1
    • 3
    • 4
  • Andy Bogart
    • 1
  • Praise O. Iyiewuare
    • 1
  • Susan C. Rosenbluth
    • 2
  • Harold Alan Pincus
    • 1
    • 5
  1. 1.RAND CorporationSanta MonicaUSA
  2. 2.VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  3. 3.UCLA Fielding School of Public HealthLos AngelesUSA
  4. 4.UCLA David Geffen School of MedicineLos AngelesUSA
  5. 5.Columbia University College of Physicians and Surgeons and New York-Presbyterian HospitalNew YorkUSA

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