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Does patient or clinician gender modify the efficacy of a primary care brief intervention for adolescent alcohol use?

  • Lilia D'Souza-Li
  • John R Knight
  • Lon Sherritt
  • Jesse Boggis
  • Sion K Harris
Open Access
Oral presentation
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Keywords

Multiple Logistic Regression Modeling Female Physician Effectiveness Trial Care Site Patient Gender 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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.

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

*p<0.05; 1 Number of patients

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.

Notes

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.

References

  1. 1.
    Harris SK, Csemy L, Sherritt L, Starostova O, Van Hook S, Johnson J, Boulter S, Brooks T, Carey P, Kossack R, Kulig JW, Van Vranken N, Knight JR: Computer-facilitated substance use screening and brief advice for teens in primary care: An international trial. Pediatrics. 2012, 129: 1072e82-CrossRefGoogle Scholar

Copyright information

© D'Souza-Li et al. 2015

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.

Authors and Affiliations

  • Lilia D'Souza-Li
    • 1
    • 3
  • John R Knight
    • 1
    • 2
  • Lon Sherritt
    • 1
    • 2
  • Jesse Boggis
    • 1
  • Sion K Harris
    • 1
    • 2
  1. 1.Boston Children's Hospital Center for Adolescent Substance Abuse ResearchBostonUSA
  2. 2.Department of PediatricsHarvard Medical SchoolBostonUSA
  3. 3.Department of Pediatrics, Faculty of Medical ScienceUniversity of CampinasCampinasBrazil

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