Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care

Jennifer F Bobb, Amy K Lee, Gwen T Lapham, Malia Oliver, Evette Ludman, Carol Achtmeyer, Rebecca Parrish, Ryan M Caldeiro, Paula Lozano, Julie E Richards, Katharine A Bradley, Jennifer F Bobb, Amy K Lee, Gwen T Lapham, Malia Oliver, Evette Ludman, Carol Achtmeyer, Rebecca Parrish, Ryan M Caldeiro, Paula Lozano, Julie E Richards, Katharine A Bradley

Abstract

Alcohol use is a major cause of disability and death worldwide. To improve prevention and treatment addressing unhealthy alcohol use, experts recommend that alcohol-related care be integrated into primary care (PC). However, few healthcare systems do so. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). Here, we describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. Across the three sites (N = 74,225 PC patients), alcohol screening increased from 8.9% of patients pre-implementation to 62% post-implementation (p < 0.0001), with a corresponding increase in assessment for alcohol use disorders (AUD) from 1.2 to 75 patients per 10,000 seen (p < 0.0001). Increases were sustained over a year later, with screening at 84.5% and an assessment rate of 81 patients per 10,000 seen across all sites. In addition, there was a 50% increase in the number of new AUD diagnoses (p = 0.0002), and a non-statistically significant 54% increase in treatment within 14 days of new diagnoses (p = 0.083). The pilot informed an ongoing stepped-wedge trial in the remaining 22 PC sites.

Keywords: alcohol drinking; alcohol use disorders; prevention; primary care.

Conflict of interest statement

The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Pre- and post-implementation periods for Sites 1–3.
Figure 2
Figure 2
Screening for unhealthy alcohol use: percentage (%) of visits with screening by week, among providers implementing Behavioral Health Integration including the Sustained Patient-centered Alcohol-related Care (SPARC) program within three PC sites.
Figure 3
Figure 3
Assessment for alcohol use disorders (AUD): percentage (%) of visits with completed AUD Symptom Checklist by month, among providers implementing Behavioral Health Integration including the Sustained Patient-centered Alcohol-related Care (SPARC) program within three PC sites.
Figure 4
Figure 4
New diagnosis and treatment for alcohol use disorders (AUD): percentage (%) of visits by month, among providers implementing Behavioral Health Integration including the Sustained Patient-centered Alcohol-related Care (SPARC) program within three PC sites.

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