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Variation in Documented Care for Unhealthy Alcohol Consumption Across Race/Ethnicity in the Department of Veterans Affairs Healthcare System
Author(s) -
Williams Emily C.,
Lapham Gwen T.,
Hawkins Eric J.,
Rubinsky Anna D.,
Morales Leo S.,
Young Bessie A.,
Bradley Katharine A.
Publication year - 2012
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/j.1530-0277.2012.01761.x
Subject(s) - medicine , veterans affairs , ethnic group , referral , health care , comorbidity , brief intervention , logistic regression , family medicine , demography , gerontology , intervention (counseling) , psychiatry , sociology , anthropology , economics , economic growth
Background The VA Healthcare System has made progress implementing evidence‐based care for unhealthy alcohol use, but whether there are differences in care across race/ethnicity is unclear. We describe alcohol‐related care for 3 racial/ethnic groups among VA outpatients with unhealthy alcohol use. Methods This cross‐sectional study utilized secondary quality improvement data collected for the VA Office of Quality and Performance (July 2006 to June 2007) to identify a sample of 9,194 black ( n = 1,436), Hispanic ( n = 500), and white ( n = 7,258) VA outpatients who screened positive for unhealthy alcohol use ( AUDIT ‐C score ≥4 men; ≥3 women). Alcohol‐related care was defined as medical record documentation of brief intervention (advice or feedback) and/or referral (discussion of or scheduled). Logistic regression models estimated the prevalence of alcohol‐related care among black, Hispanic, and white patients after adjustment for sociodemographic characteristics, alcohol use severity, other substance use, and mental health comorbidity. Results Among all eligible patients, 2,903 (32%) had documented alcohol‐related care. Adjusted prevalences were 35.3% (95% CI 30.0 to 40.5) for black, 27.3% (95% CI 21.1 to 33.5) for Hispanic, and 28.9% (95% CI 25.5 to 32.3) for white patients. Differences in documented alcohol‐related care between all racial/ethnic groups were significant ( p ‐values all < 0.05). Conclusions Among VA patients with unhealthy alcohol use, black patients had the highest, and Hispanic the lowest, prevalence of documented alcohol‐related care. Future research should evaluate contextual and system‐, provider‐, or patient‐level factors that may attenuate racial/ethnic differences in documented alcohol‐related care, as well as whether differences in documented care are associated with differences in outcomes.