Doctor-Older Patient Communication About Alcohol Misuse

DESCRIPTION (provided by applicant): Risky alcohol use and prescription drug misuse have a substantial impact on the productivity and health of middle aged and older Americans. Federal Consensus Panels, the NIAAA, and the AMA have recommended that primary care clinicians screen adult patients for substance use problems and disorders with the most pressing needs emerging among older patients (Blow, 1998). Brief, office-based counseling and other tested strategies are efficacious and cost-effective. Yet less than 20% of physicians consider themselves prepared to assess or treat alcohol and drug misuse. The New England Research Institutes proposes to develop and evaluate an interactive Web-based, CME-accredited continuing education program in doctor-older patient communication about alcohol and prescription drug misuse. This program will present the physician guidelines established by NIAAA (2003) and the elder-specific guidelines of the American Medical Association (1997) in combination with scientific knowledge about physician-older patient relationships and barriers to treatment and prevention. The program will be the first to 1) synthesize established recommendations and assessment techniques for older persons and 2) maximize use of Web technologies to portray both the "science" and the "art" of effective drug and alcohol screening in the primary care arena, the front line of older adults' health care. A team of accomplished researchers and web producers at the New England Research Institutes will be assisted in content development by Jeffrey H. Samet, MD, past president of the Association for Medical Education and Research in Substance Abuse and two other clinical consultants. The Specific Aims of Phase I are to: 1) develop the content outline for the full Web-based program; 2) define and test the technical design and user-appropriate format; 3) fully develop a prototype chapter with input from target-group interviews; 4) conduct a feasibility assessment of the proposed program; and, 5) outline a Phase II plan with proposed refinements to the design and format, a schedule for producing the full-length program (with CME- accreditation), and a full evaluation plan. The completed program will be available through NERI's e- commerce site and marketed to the quarter million primary care physicians in the US. The program can also be used in medical schools and by advance practice nurses.