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There is a critical need to improve linkage to alcohol care for veterans in primary care with hazardous drinking and PTSD and/or depression symptoms (A-MH). We adapted an alcohol care linkage intervention, "Connect to Care" (C2C), for this population. We conducted separate focus groups with veterans with A-MH, providers, and policy leaders. Feedback centered on how psychologists and other providers can optimally inform veterans about their care options and alcohol use, and how to ensure C2C is accessible. Participants reported that veterans with A-MH may not view alcohol use as their primary concern but rather as a symptom of a potential co-occurring mental health condition. Veterans have difficulty identifying and accessing existing alcohol care options within the Veterans Health Administration. C2C was modified to facilitate alcohol care linkage for this population specific to their locality, provide concrete support and education, and offer care options to preserve privacy., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Aims and Objectives: This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression., Background: Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted., Design: Systematic review., Methods: We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population., Results: Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population., Conclusions: Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes., Relevance to Clinical Practice: Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are effective for identifying unhealthy substance use and associated with healthy behaviours and improved outcomes. Lacking are studies screening for illicit drug use, and using single-item screening tools, which could be especially helpful for frontline primary care providers including nurses., (Published 2016. This article is a U.S. Government work and is in the public domain in the USA.)

Aim: This article presents a conceptual model to help facilitate the transition from primary care to specialty substance use disorder (SUD) care for appropriate patients., Background: Substance misuse is a common health condition among patients presenting to primary care settings and may complicate the treatment of chronic health conditions such as diabetes and hypertension. It is therefore critical that primary care providers be prepared to identify and determine appropriate treatment options for patients presenting with substance misuse., Methods: We conducted a narrative review that occurred in three stages: literature review of health care transition models, identification of conceptual domains common across care transition models, and identification of SUD-specific model elements. Findings The conceptual model presented describes patient, provider, and system-level facilitators and barriers to the transition process, and includes intervention strategies that can be utilized by primary care clinics to potentially improve the process of transitioning patients from primary care to SUD care. Recognizing that primary care clinics vary in available resources, we present three examples of care practices along an intensity continuum from low (counseling and referral) to moderate (telephone monitoring) to high (intensive case management) resource demands for adoption. We also provide a list of common outcomes clinics might consider when evaluating the impact of care transition practices in this patient population; these include process outcomes such as patients' increased knowledge of available treatment resources, and health outcomes such as patients' reduced substance use and better quality of life.

Despite long-standing recommendations that patients with substance use disorders receive primary care, only one-half of patients with substance use disorders receive such care. This article presents a conceptual model to facilitate the transition of patients from addiction treatment to primary care. A narrative review of the healthcare transition literature was conducted with an emphasis on identifying substance use disorder-specific model elements. The resulting model is intended to guide addiction treatment and primary care providers and researchers in understanding factors that impact care coordination between addiction treatment and primary care and to provide an overview of evidence-based methods for supporting this care transition.

Background: The Veterans Health Administration (VHA) is implementing the patient-centered medical home (PCMH) model of primary care which emphasizes patient-centered care and the promotion of healthy lifestyle changes. Motivational Interviewing (MI) is effective for promoting various health behaviors, thus a training protocol for primary care staff was implemented in a VHA health care setting., Objectives: We examined the effect of the training protocol on MI knowledge, confidence in ability to use MI-related skills and apply them to written vignettes, perceived comfort level and skill in lifestyle counseling, and job-related burnout., Design: Training was provided by experts in MI. The training protocol consisted of three sessions--one half day in-person workshop followed by a 60-minute virtual training, followed by a second workshop. Each of the sessions were spaced two weeks apart and introduced trainees to the theory, principles, and skills of using MI in health care settings., Participants: All primary care staff at the Veterans Affairs Palo Alto Health Care System were invited to participate., Measurements: Trainees completed a short set of questionnaires immediately before and immediately after the training., Results: We found support for our primary hypotheses related to knowledge, confidence, and written responses to the vignettes. Changes in perceived comfort level and skill in lifestyle counseling, and job-related burnout were not observed., Conclusions: Training primary care staff in MI is likely to become increasingly common as health care systems transition to the PCMH model of care. Therefore, it is important for health care systems to have low-cost methods for evaluating the effectiveness of such trainings. This study is a first step in developing a brief written assessment with the potential of measuring change in a range of behaviors and skills consistent with MI.

Background. Although rates of unhealthy drinking are high among women Veterans with mental health comorbidities, most women Veterans with mental comorbidities who present to primary care with unhealthy drinking do not receive alcohol-related care. Barriers to alcohol-related treatment could be reduced through patient-centered approaches to care, such as shared decision-making.Aims. We assessed the feasibility and acceptability of a telephone-delivered shared decision-making intervention for promoting alcohol behavior change in women Veterans with unhealthy drinking and co-morbid depression and/or probable post-traumatic stress disorder.Methods. We used 3, 2-hour focus group discussions with 19 women Veterans to identify barriers and solicit recommendations for using the intervention with women Veterans who present to primary care with unhealthy drinking and mental health comorbidities. Transcripts from the focus groups were qualitatively analyzed using template analysis.Results. Although participants perceived that the intervention was feasible and acceptable for the targeted patient population, they identified the treatment delivery modality, length of telephone sessions, and some of the option grid content as potential barriers. Facilitators included strategies for enhancing the telephone-delivered shared decision-making sessions and diversifying the treatment options contained in the option grids. Focus group feedback resulted in preliminary adaptations to the intervention that are mindful of women Veterans' individual preferences for care and realistic in the everyday context of their busy lives. [ABSTRACT FROM PUBLISHER]

Background: Unhealthy drinking is relatively common among women U.S. military Veterans. Primary care is often the setting where patients first come into contact with the health care system, and providers in this setting play a critical role in connecting unhealthy drinkers to appropriate care. Little is known about primary care providers' perspectives on factors that affect whether women Veterans presenting to primary care with unhealthy drinking connect to alcohol-related care. Understanding factors that affect whether patients connect to alcohol-related care may improve providers' ability to support women Veterans with unhealthy drinking get needed care.Methods: This qualitative study used semi-structured interviews with 14 providers from two Veterans Administration Women's Health primary care clinics, including nurses, nurse practitioners, physicians' assistants, and physicians, and colocated mental health providers. The interviews were transcribed, and themes pertaining to providers' perspectives on barriers and facilitators to connecting women Veterans' with unhealthy drinking to alcohol-related care were identified through template analysis.Findings: Primary care providers perceived numerous provider- and clinic-level factors as relevant to their ability to connect women Veterans to alcohol-related care. Barriers providers described were insufficient care resources, provider prioritization of alcohol-related care, insufficient knowledge of care options or the referral process among providers, time constraints during routine clinical visits, and the referral process for alcohol-related care. They also described resources available in primary care, primary care provider behaviors, and initiatives at the Veterans Administration as helpful.Discussion: Although primary care providers are gatekeepers to specialty treatment services, ongoing education, and colocated mental health staff could help reduce barriers to these services, ultimately improving health outcomes for women Veterans and others with unhealthy drinking. [ABSTRACT FROM AUTHOR]

The article reports on a study which identify factors associated with women Veterans' receptivity to recommendation for alcohol related care when they present to Veterans Affairs (VA) primary care with alcohol misuse. It states that qualitative analyses identified several themes associated with women's receptivity which included self-appraisal of drinking behavior as severe, the provider's presentation of treatment options and availability of gender-specific services.

Background One in five women veterans screens positive for alcohol misuse. Women may be less likely than men to disclose alcohol use to a primary care provider (PCP), resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may affect women veterans' willingness to disclose alcohol use to a PCP. Methods Between October 2012 and May 2013, in-depth interviews were conducted with 30 women veterans at two Department of Veterans Affairs (VA) medical facilities. Qualitative data analyses identified common themes representing factors that influence women's decision to disclose alcohol use to a PCP. Findings Nine themes were endorsed by women veterans as influencing their willingness to disclose alcohol use to their PCP. Themes included provider behaviors perceived as encouraging or discouraging disclosure of alcohol misuse, perceived positive relationship with provider, negative emotions such as concerns about being judged or labeled an “alcoholic,” health concerns about drinking, non–health-related concerns about drinking, self-appraisal of drinking behavior, social support, and clinic factors. Conclusions Our findings demonstrate the importance of social relationships, comfort with one's provider, and education on the potential harms (especially health related) associated with alcohol in encouraging disclosure of alcohol use in women veterans. Our results also support VA national health care efforts, including the provision of brief alcohol counseling and the use of primary care clinics specializing in the care of women veterans. [ABSTRACT FROM AUTHOR]

Alcohol misuse and post-traumatic stress disorder (PTSD) are highly prevalent among veterans presenting to primary care. PTSD is associated with depression and increased substance use which can complicate the treatment of alcohol misuse. No studies have examined severity of depressive symptoms, rates and type of illicit drug use, and alcohol use severity in veterans with PTSD and alcohol misuse in primary care. Therefore, we examined (a) rates of PTSD and associated mental health comorbidities (depression, suicidal ideation), (b) current and lifetime illicit drug use and (c) alcohol use severity in relation to PTSD status in a sample of veterans presenting to primary care with alcohol misuse. We also tested the hypothesis that greater depressive symptoms, illicit drug use and alcohol use severity would be independently associated with greater likelihood of PTSD, after controlling for age and ethnicity. Veterans (N = 166) were recruited from primary care as part of an intervention study between the years 2010 and 2011. Veterans participating in the study completed an in-person semi-structured interview with study staff. Using the post-traumatic Stress Disorder Checklist-Military version, we found a 16.3% rate of PTSD. PTSD was associated with greater depressive symptoms, rates of suicidal ideation, alcohol use severity, current use of hypnotics and lifetime use of cocaine and amphetamines. Using logistic regression, we found that severity of depressive symptoms and lifetime cocaine use were independently associated with greater likelihood of PTSD, after controlling for age and ethnicity. Treatment implications of these findings are discussed. [ABSTRACT FROM PUBLISHER]

Substance abuse treatment utilization and patient characteristics of veterans (N= 167) drinking alcohol at risky levels at a Department of Veterans Affairs hospital were examined. Rates of brief intervention and specialty care were higher than those found in national samples in 2010, but fall short of recommended guidelines. Veterans receiving more care were older, lower-income, and less likely to be in a relationship. Care-receiving veterans had higher rates of mental health comorbidities and mental health treatment in the prior year for an issue other than substance use. Understanding patients’ recent care history may help primary care providers to deliver care effectively. [ABSTRACT FROM AUTHOR]