[unreadable] DESCRIPTION (provided by applicant): Problem: Many efficacy trials have shown that brief interventions by primary care clinicians help hazardous and harmful drinkers moderate their alcohol consumption. Several studies have also shown reductions in morbidity up to four years after the intervention, and one study found a decrease in all-cause mortality. Few clinicians practice brief [unreadable] interventions and few receive training in screening and brief intervention (SBI). Most primary care residents and faculty have not received training in SBI, and the most effective methods of reinforcing ongoing use of SBI techniques following initial training are not known. Purpose: To aid in translating SBI techniques into residency training and clinical practice. Specific Aims: Building on successful pilot projects at the investigators' home institutions, we propose an innovative training approach with 3 specific aims: (1) utilize a combination of clinician training and systems intervention to train faculty and residents at 8 primary care residency programs to perform SBI, (2) utilize team learning activities to reinforce continued use of SBI behaviors, and (3) prepare residents to perform SBI in their [unreadable] future practices. Methods: We will utilize methods pioneered in the U. of Connecticut's "Cutting Back" program and pilot tested for residency use in the Macon Healthy Habits Project to train faculty, residents and staff to routinely perform alcohol SBI in 8 residency-based family practice clinics. Implementation steps will include involving multi-level clinic staff in program planning, providing each clinician with experientially-based interview training, adapting clinic procedures to screen all adult patients for hazardous and harmful drinking using existing staff, and prompting clinicians to perform; interventions on screen-positive patients. Team learning, an innovative teaching method, will be used in combination with compliance feedback to reinforce continued use of SBI behaviors. In Year 2, graduating residents trained in SBI will participate in focus groups evaluating the strengths and weaknesses of the SBI training program and exploring methods for incorporating SBI techniques [unreadable] in their future practices. All residents will receive a tool kit of screening and intervention materials for future use. [unreadable] [unreadable] Evaluation: Patient exit interviews will be used to monitor SBI rates at each residency clinic, using pre- and postimplementation comparisons. Clinician questionnaires based on the Transtheoretical Model of behavior change will be used to monitor changes in clinician motivation and perceived importance and self-efficacy in performing SBI activities. Conference evaluations will assess the utility of team learning in reinforcing SBI behaviors. Focus groups will be used to assess key barriers to implementation and continuation of SBI practices. Post-graduation surveys will measure use of SBI techniques by residents after they enter their own practices. Benefit: This program will assist in translating SBI research findings into family practice residency programs and set the stage for further translation into post-residency practices. [unreadable] [unreadable]
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