Gender Differences in Alcohol Screening, Brief Intervention, and Referral to Treatment in Primary Care

Background/Aims: Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in adult primary care is efficacious in reducing hazardous drinking and is widely recommended. This study examines whether there are gender disparities in receipt of alcohol SBIRT among adult primary care patients by analyzing data from the ADVISe study, a clustered randomized controlled trial on SBIRT implementation by primary care physicians (PCP) and nonphysician providers (NPP) in a large, integrated health care delivery system. Methods: This observational prospective cohort study examined electronic health record data on 639,593 adult patients who had a primary care visit at an ADVISe study clinic during Year 1 of the study. We conducted bivariate analyses to examine differences between males and females in demographic and clinical characteristics, screening rates and BI/RT rates among those who screened positive. Within each intervention arm, multilevel logistic regression models were fitted to further assess the associations between patient gender and receipt of alcohol SBIRT while adjusting for other covariates at patient, physician and system levels and accounting for clustering within physician and within clinic correlation of patient outcomes. Results: Findings from multilevel logistic regression models suggested that women were less likely to be screened in both intervention arms (odds ratios [95% confidence intervals]: 0.78 [0.75–0.82] for the PCP arm and 0.82 [0.77–0.87] for the NPP arm). Among those who screened positive, women were less likely to receive BI/RT in both intervention arms (odds ratios [95% confidence intervals]: 0.60 [0.48–0.76] for the PCP arm and 0.62 [0.51–0.77] for the NPP arm). The presentation also will include findings of outcomes by gender and age. Conclusion: Better understanding of the unique patient-, provider- and system-level factors that are associated with receipt of alcohol SBIRT and outcomes for males and females, and strategies to address such factors, are needed