PHYSICANS ROLE IN REDUCING PATIENTS ALCOHOL/HIV RISKS

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APPLICANT'S ABSTRACT: Alcohol misuse and HIV/AIDS cause significant morbidity and mortality in the United States, with devastating health, social, and economic consequences. Primary health care settings offer ideal locations to initiate prevention efforts to reduce this morbidity and mortality. Because patients view primary care physicians as credible sources of health information, physicians have the potential to influence patients' risky behaviors. Yet the majority do not assess or counsel patients for alcohol or HIV risks despite long-standing calls for them to do so. To date, few studies have tested strategies for reducing the barriers facing physicians and we know of no studies that have examined the importance of physician involvement in alcohol- or HIV-preventive interventions. We propose to test the effectiveness of physician behavioral change intervention on improving physicians' knowledge, attitudes, and practices regarding reducing patients' alcohol and HIV risks. Physicians randomly assigned to an Experimental Group will receive a 2-hour intervention consisting of a skills-based course and practice-based newsletters; they will also receive two booster-training sessions. We also propose to compare the effectiveness of four interventions to reduce primary care patients' alcohol-and HIV-risk behaviors: a physician-directed brief intervention, a physician-directed intensive intervention, a computer-directed brief intervention, or a computer-directed intensive intervention. At-risk patients will be identified by a computerized risk assessment tool and randomly assigned within physician groups to one of the four interventions. In the physician-directed brief intervention, patients will receive a 5-minute intervention from their primary care physicians aimed at informing them about their risks, advising them to reduce risky behaviors, assisting them in setting behavioral change goals, and referring them to counseling services. In the physician-directed intensive intervention patients will receive the same 5-minute intervention plus referral to a four-session MET intervention to be conducted by a specially trained health-risk counselor. Physicians will introduce patients to the counselors who will, over three months, meet individually with patients for four sessions to deliver an alcohol and HIV intervention based on the MET model, which has been shown to be effective at reducing problem drinking. In the computer-directed brief intervention, the computer will inform patients about their alcohol and HIV risks, advise them to reduce their risks, assist them in setting behavioral change goals, and refer them to counseling. In the computer-directed intensive intervention, patients will receive the same brief intervention plus immediate referral to the health-risk counselor to schedule an appointment to begin the four-session MET intervention. The main outcome measures will be reductions in patients' alcohol and HIV risks as assessed by computer at baseline, post-intervention (3 months after the baseline assessment), and at a 6-month follow-up assessment. If, as we hypothesize, the intervention effectively reduces patients' risk behaviors, this intervention could be implemented by other health care settings to reduce the morbidity and mortality associated with alcohol and HIV risk behaviors.