Background
A previous large, multi-site trial showed that computer-facilitated screening and physician brief advice (cSBA) was an effective way to reduce adolescents' alcohol use[1]. What is unknown is whether the intervention effect varies by patients' or physicians' characteristics, such as gender. We assessed whether patient and physician gender moderates cSBA effectiveness.
Material and methods
We analyzed a subset of data from a quasi-experimental, asynchronous effectiveness trial of 12-18 y/o patients at primary care sites. An initial 18-month Treatment as Usual (TAU) phase was followed by a 1-hour physician training and an 18-month cSBA phase with computerized screening, immediate feedback and information on the health risks of drugs, follow by physicians brief advice. Adolescents rated their visit and physician immediately post-visit. Only data for physicians with >5 patients in each study arm were included. We conducted stratified multiple logistic regression modeling with adjustment for known covariates and within-site clustering. Endpoints were past 3- and 12-month alcohol at follow-ups.
Anzeige
Results
Subjects: 20 physicians (11 females; 85% pediatricians) and 1158 patients, mean age 15.6+2.0 yrs. Youth-provider connectedness was high (median score 32 [IQR 29-34] out of 35 max). However, female physicians' patients scored significantly higher on youth-provider connectedness than patients of male physicians (p<0.0001), regardless of patient gender. The 3-month effect of cSBA on adolescent alcohol use was stronger among girls and female physicians (Table 1).
Table 1
Adjusted relative risk ratios (ARRR) comparing cSBA vs. TAU adolescent alcohol use rates at 3 and 12 months post-visit.
3 MONTHS | 12 MONTHS | |||
|---|---|---|---|---|
ARRR | 95%CI | ARRR | 95% CI | |
Girl patient (n=546) | 0.47* | 0.25-0.87 | 0.82 | 0.52-1.31 |
Boy patients (n=612) | 0.54 | 0.26-1.19 | 0.71 | 0.45-1.11 |
Female doctors(n=6581) | 0.41* | 0.22-0.76 | 0.63 | 0.38-1.03 |
Male doctors (n=5001) | 0.62 | 0.30-1.29 | 0.77 | 0.50-1.17 |
Conclusion
Physician advice regarding alcohol use may be particularly effective for girls within the context of an ongoing relationship with their physician, and when delivered by female physicians whose care is associated with higher patient-provider connectedness.
Acknowledgements
The authors thank the physicians and staff of The New England Partnership for Substance Abuse Research for their help in implementation of the original study, to the adolescent patients who participated and their parents who gave permission and the funding agencies: National Institute on Drug Abuse R01DA018848 and R01DA018848e03S1; National Institute on Alcohol Abuse and Alcoholism K07 AA013280; CNPq 202418/2014; CAPES BEX 6951/14-7.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.