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Addressing Alcohol Problems in Primary Care: A Cluster Randomized, Controlled Trial of a Systems Intervention: The Screening and Intervention in Primary Care (SIP) Study

Richard Saitz, MD, MPH; Nicholas J. Horton, ScD; Lisa M. Sullivan, PhD; Mark A. Moskowitz, MD; and Jeffrey H. Samet, MD, MA, MPH
[+] Article and Author Information

From Boston University and Boston Medical Center, Boston, Massachusetts.


† Deceased.

Preliminary results were presented at the annual national meetings of the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program in Tucson, Arizona, on 9 December 1999 and in San Diego, California, on 7 December 2000; the Society of General Internal Medicine in Boston, Massachusetts, on 4 May 2000 and in San Diego, California, on 4 May 2001; the Association for Medical Education and Research on Substance Abuse in Alexandria, Virginia, on 5 November 1999 and 4 November 2000; and the Research Society on Alcoholism in Montreal, Quebec, Canada, on 25 June 2001.

Note: The authors acknowledge the contributions of Dr. Moskowitz, who died in September 2001. Dr. Moskowitz, despite his busy role as chief of a large section of general medicine and busy clinician and health services researcher, always had time, night or day, to provide immediate and critical feedback to mentees who will long remember his insights.

Acknowledgments: The authors thank the Primary Care Clinic staff and the patients and physicians who participated in the Screening and Intervention in Primary Care (SIP) study; staff researchers M. Alexandra Ordoñez, Raymond Quon, and Noelia Kvaternik; medical students participating in the Summer Substance Abuse Research Fellowship; and DM-STAT (Medford, Massachusetts) for their meticulous data management.

Grant Support: By the Robert Wood Johnson Foundation (grant 031489), Princeton, New Jersey. Dr. Saitz previously received support from the Robert Wood Johnson Foundation as a Generalist Physician Faculty Scholar and currently receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) (Clinical Research Curriculum Award grant 1 K30 HL04124); he and Dr. Samet received support from the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration (Faculty Development grant T26-SP08355). Drs. Saitz, Samet, and Horton are also supported by the NIH National Institute on Alcohol Abuse and Alcoholism (R01 AA10870, AA12617, AA13216), and the NIH National Institute on Drug Abuse (R01 DA10019).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Richard Saitz, MD, MPH, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118-2393; e-mail, rsaitz@bu.edu.

Current Author Addresses: Drs. Saitz, Horton, and Samet: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118-2393.

Dr. Sullivan: Department of Mathematics and Statistics, Boston University Statistics & Consulting Unit, 111 Cummington Street, Boston, MA 02215.

Author Contributions: Conception and design: R. Saitz, N.J. Horton, L.M. Sullivan, M.A. Moskowitz, J.H. Samet.

Analysis and interpretation of the data: R. Saitz, N.J. Horton, L.M. Sullivan, J.H. Samet.

Drafting of the article: R. Saitz, N.J. Horton, L.M. Sullivan, J.H. Samet.

Critical revision of the article for important intellectual content: R. Saitz, N.J. Horton, L.M. Sullivan, M.A Moskowitz, J.H. Samet.

Final approval of the article: R. Saitz, N.J. Horton, L.M. Sullivan, J.H. Samet.

Provision of study materials or patients: R. Saitz.

Statistical expertise: N.J. Horton, L.M. Sullivan.

Obtaining of funding: R. Saitz.

Administrative, technical, or logistic support: M.A. Moskowitz.

Collection and assembly of data: R. Saitz, N.J. Horton, L.M. Sullivan.


Ann Intern Med. 2003;138(5):372-382. doi:10.7326/0003-4819-138-5-200303040-00006
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Of 82 physicians in the practice, 76 (93%) returned the survey; 50 had sufficiently complete surveys, had adequate panel size, and anticipated remaining in the practice (Figure 1). These 50 were randomly assigned to the intervention or control group. Initially, 40 physicians were randomly selected to participate. During the study, 6 physicians had no patients enrolled after 6 to 9 months and an additional 7 eligible physicians who were previously randomly assigned were entered into the study to ensure sufficient patient enrollment. Eligible and ineligible physicians were of similar age, year of medical school graduation, race, sex, and level of training.

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Figure 1.
Physician enrollment and randomization.
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Figure 2.
Patient enrollment and follow-up.

* One patient had missing data on drinking.

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Appendix Figure. Form used when a patient reported hazardous drinking amounts but no affirmative CAGE screening questionnaire responses. Form used when a patient reported affirmative CAGE responses but did not drink hazardous amounts. Form used when a patient reported both hazardous drinking amounts and affirmative CAGE responses. The back of the form for all three versions was the same.
Three versions of the intervention to increase counseling for alcohol problems.A.B.C.D.
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Summary for Patients

Finding and Treating Alcohol Problems in Primary Care

The summary below is from the full report titled “Addressing Alcohol Problems in Primary Care: A Cluster Randomized, Controlled Trial of a Systems Intervention. The Screening and Intervention in Primary Care (SIP) Study.” It is in the 4 March 2003 issue of Annals of Internal Medicine (volume 138, pages 372-382). The authors are R Saitz, NJ Horton, LM Sullivan, MA Moskowitz, and JH Samet.

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