SBIR-STTR Award

Alcohol use in the elderly causes or exacerbates common medical and psychosocial conditions including heart disease, stroke, falls and depression. We propose to develop and test a computerized system to diagnose presence of and risks for alcohol related conditions in the elderly. The computerized system (CARPS) will consist of (1) a machine-readable questionnaire (the Alcohol-Related Problems Survey: ARPS); (2) algorithms based on 398 indications of harmful hazardous, and non hazardous drinking selected by a national panel of Experts and tested in 700 persons; (3) computer software linking ARPS' results to appropriate algorithms; and (4) reports for study participants and providers. Focus groups of participants and experts in geriatrics will design report forms. We will test CARPS in a health setting. CARPS will be the only available automated system for the elderly that uses clinically meaningful, evidence- based algorithms. It will be useful in health and social senior settings and to managed care organizations concerned with identifying preventable and treatable health problems. The program generating CARPS reports will interface with other via an ASCII file format, so the product can also be used for quality improvement and research as well as for clinical care. Phase 2 will test CARPS' impact on alcohol-related behaviors and health services utilization. PROPOSED COMMERCIAL APPLICATION: CARPS can be used in health settings where the concern is to efficiently diagnose alcohol use disorders in the elderly. These include physicians' offices and medical clinics, senior centers, continuing care communities, psychiatric in-patient and out-patient settings, social work settings, home health care contexts, and emergency departments. Managed care organizations and health insurers are particularly concerned with efficiency and will find the product beneficial. CARPS can also be used to quality improvement activities and research as well as in clinical care.

This study is a randomized trial of the effectiveness and feasibility of the Computerized Alcohol-Related Problems System (CARPS), a self- administered screen to detect and report on non-hazardous, hazardous and harmful alcohol use in older adults. The CARPS consists of a scannable version of a reliable alcohol screen, a personalized Report of each patient's drinking classification, individualized alcohol education, and the capacity to store responses in a relational database. The CARPS was developed because of the paucity of effective and usable screens for older adults. In the elderly, one or two daily drinks may worsen common medical problems (e.g., depression) because of age-related changes and interactions between alcohol, medication-use and diminishing functional status. About 40% may be at risk; hospitalization rates for alcohol problems equal those for myocardial infarction. In this study, experimental primary care patients at a community practice will be randomly assigned to one of two experimental groups or a control. In Group 1, patients alone receive a Report; in Group 2, patients and physicians both receive Reports. The control group receives usual care. Effectiveness us evaluated by examining improvements in knowledge and self-efficacy and reductions in alcohol-related risks and health services utilization. Feasibility is evaluated by unobtrusive observations. PROPOSED COMMERCIAL APPLICATIONS: The CARPS can be used in all health settings to efficiently screen for and diagnose alcohol use disorders in the elderly. This includes physicians' offices and medical clinics, senior centers, and continuing care communities. Managed care organizations and health insurers are particularly concerned with efficient methods of detecting and preventing risks for health problems and will find the product beneficial, especially because no other product like it is available. The CARPS is user friendly. It can be used in quality improvement activities and research as well as in clinical care.