Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial

Alison N Huffstetler, Anton J Kuzel, Roy T Sabo, Alicia Richards, E Marshall Brooks, Paulette Lail Kashiri, Gabriela Villalobos, Albert J Arias, Dace Svikis, Beth A Bortz, Ashley Edwards, John Epling, Deborah J Cohen, Michael L Parchman, Jonathan Winter, Patricia Wessler, Timothy J Yu, Alex H Krist, Alison N Huffstetler, Anton J Kuzel, Roy T Sabo, Alicia Richards, E Marshall Brooks, Paulette Lail Kashiri, Gabriela Villalobos, Albert J Arias, Dace Svikis, Beth A Bortz, Ashley Edwards, John Epling, Deborah J Cohen, Michael L Parchman, Jonathan Winter, Patricia Wessler, Timothy J Yu, Alex H Krist

Abstract

Background: Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Medication assisted therapy (MAT) is another effective method for treatment of moderate or severe alcohol use disorder. Yet, primary care clinicians are not regularly screening for or treating unhealthy alcohol use.

Methods and analysis: We are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and MAT. One hundred and 25 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) will be engaged; each will receive practice facilitation to promote screening, counseling, and MAT either at the beginning of the trial or at a 6-month control period start date. For each practice, the intervention includes provision of a practice facilitator, learning collaboratives with three practice champions, and clinic-wide information sessions. Clinics will be enrolled for 6-12 months. After completion of the intervention, we will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation.

Discussion: This study offers a systematic process for dissemination and implementation of the evidence-based practice of screening, counseling, and treatment for unhealthy alcohol use. Practices will be asked to implement a process for screening, counseling, and treatment based on their practice characteristics, patient population, and workflow. We propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice. We believe that the process can be replicated and used in a broad range of clinical settings; we anticipate this will be supported by our evaluation of this approach.

Trial registration: ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT04248023, Registered 5 February 2020.

Keywords: Preventive care; Primary care; Risk reduction; SBIRT; Unhealthy alcohol use.

Conflict of interest statement

No authors have any financial conflicts of interest. Dr. Krist is the chair of the United States Preventive Services Task Force (USPSTF). This article does not necessarily represent the views and policies of the USPSTF.

Figures

Fig. 1
Fig. 1
Consort – Implementation Study Flow Diagram
Fig. 2
Fig. 2
Screening, Counseling, and Treatment for Unhealthy Alcohol in Primary Care: Relationship Between SBI, Stepped Care, MAT, and Community Referral

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