BMC Public Health 2009, 9:101 http://www.biomedcentral.com/1471-2458/9/101 Table 3: Predictors of Improvement Immediately After a Primary Care Physician Visit Improvemen t in Readiness (1–10) Importance (1–10) Confidence (1–10) RTCQ (-24- +24) Female Age White No Partner Drinks per day Alcohol consequences (SIP score) Discussion with physician Illicit drug use Mean adjusted change -0.37 0.01 -1.41 1.06 0.02 -0.03 0.78 -0.03 (95% CI) (-1.19, 0.46) (-0.02, 0.04) (-2.31, -0.51) (0.30, 1.81) (-0.08, 0.12) (-0.06, 0.00) (0.05, 1.51) (-0.75, 0.68) Mean adjusted change 0.21 -0.01 -0.09 -0.05 0.04 -0.01 0.16 -0.51 (95% CI) (-0.34, 0.77) (-0.03, 0.02) (-1.06, 0.89) (-0.65, 0.55) (-0.10, 0.18) (-0.04, 0.01) (-0.46, 0.79) (-1.27, 0.24) Mean adjusted change -0.32 0.00 -0.36 -0.21 -0.01 0.01 -0.07 0.07 (95% CI) (-0.98, 0.34) (-0.03, 0.03) (-0.86, 0.14) (-0.79, 0.37) (-0.06, 0.05) (-0.03, 0.05) (-0.60, 0.46) (-0.52, 0.66) Mean adjusted change 0.57 0.01 1.24 0.09 -0.03 0.03 1.14 0.87 (95% CI) (-0.26, 1.41) (-0.03, 0.04) (0.10, 2.39) (-1.07, 1.25) (-0.18, 0.11) (-0.02, 0.07) (0.04, 2.25) (-0.41, 2.16) SIP: Short Inventory of Problems RTCQ: Readiness To Change Questionnaire Bold entries have p-values < 0.05 Being white was a negative predictor of change in readi- ness (white versus other: -1.41, p = 0.002). Age, gender, alcohol consumption and alcohol-related problems were not significant predictors. Similarly for readiness meas- ured by the RTCQ, discussion with the physician about the patient's alcohol consumption was a significant pre- dictor of an increase (+1.14 points, p = 0.04). However, not having a partner was not significantly associated with an increase in RTCQ-measured readiness, and being white was associated with an increase (not a decrease) (+1.24, p = 0.03). None of the predictors were significantly associ- ated with increases in importance and confidence. Pre-visit to 6-month follow up changes Of the 173 subjects, 62 (36%) reported not drinking risky amounts during 30 days prior to the 6-month follow-up interview. But most subjects had improvements in drink- ing or readiness, importance and confidence: 62% were no longer drinking risky amounts or had improved readi- ness, 58% were not drinking risky amounts or had improved importance, and 56% were not drinking risky amounts or had improved confidence. Similarly, 67% of subjects were not drinking risky amounts or had improved RTCQ-readiness. We assessed the proportion of subjects who had improved because of a change in drink- ing. Of the 98 subjects who had improved drinking or readiness, 54 (55%) were no longer drinking risky amounts and 44 (45%) were still drinking risky amounts but had improved readiness. For improvement in drink- ing or importance, 62 (62%) had improved drinking, 38 (38%) improved importance; for improvement in drink- ing or confidence, 62 (64%) improved drinking, 35 (36%) confidence. Results were similar for improvement in drinking or RTCQ-readiness (62 (54%) had improved drinking, 53 (46%) improved RTCQ score. In adjusted analyses, few predictors of improvement were identified. Not having a partner was a significant predictor of improvement in drinking or importance (p = 0.007), and drinking or confidence (p = 0.005). Being white was a negative predictor of improvement in drinking or readi- ness (p = 0.007). No other predictors were significantly associated with improvements in the hypothesized direc- tion. Unexpectedly, having a discussion with the physi- cian (at the initial visit) was a negative predictor (p = 0.03) of improvement in drinking or importance (Table 4). Discussion We assessed variations in readiness, importance and con- fidence regarding changing drinking after a single primary care physician visit and improvements in these constructs and drinking 6 months later. After the visit, we observed significant increases in readiness, importance, and confi- dence. The effects were small (i.e. 1 point for readiness, 0.16 for importance, 0.49 for confidence, on a 1 to 10 scale). However, a clinically significant change in these constructs has not yet been well-defined, and the impact of changes of any magnitude is not known. Based on the transtheoretical model and motivational interviewing, cli- nicians are encouraged to help patients increase motiva- tion, which in turn is expected to lead eventually to behavior change [10,35]. After a physician visit we can detect the beginning of such changes. Having a discussion about alcohol with the physician appeared to have an additional impact on readiness to change, an effect that was no longer detectable 6 months later. Like other meas- Page 5 of 9 (page number not for citation purposes)