Alcohol use is the third greatest cause of disability and death for US adults. Alcohol misuse refers to the spectrum ranging from drinking above recommended limits to alcohol use disorders ("AUD"). Care for alcohol misuse is generally neglected in primary care (PC). Two types of evidence-based care for alcohol misuse are lacking: preventive care and treatment of AUD. Evidence-based preventive care consists of alcohol screening and, for patients who screen positive, brief patient-centered counseling. This is called "screening and brief intervention" (SBI), and is recommended by the US Preventive Services Task Force (USPSTF). Most PC practices do not offer SBI. Evidence-based treatments for AUD include counseling, medications, and/or specialty treatment. In spite of these options, however, few patients with AUD are offered treatment and when they are, referral to group-based specialty addictions treatment is often all that is offered. Many patients do not find the offered treatment acceptable, and 91% of those with AUD do not receive alcohol treatment. These gaps in care result from complex historical and social factors. Alcohol misuse is stigmatized, alcohol treatment has historically been offered outside medical settings, and AUD treatment is neglected in health professional training. PC clinicians often do not perceive care for alcohol misuse as central to their practice. Objective: The proposed project will use three strategies to improve the quality of care for alcohol misuse in the 25 PC clinics of a regional health system-Group Health Cooperative (GHC): (1) enabling with proven methods for obtaining buy-in, and improving attitudes, skills, knowledge and self-efficacy;(2) supporting with an electronic health record (EHR);and (3) monitoring and feedback on performance by PC leaders. Implementation Plan: Currently, there is no systematic documentation of SBI for the estimated 381,550 patients who receive PC in GHC, and only an estimated 148 patients a year are provided treatment for AUD. We will leverage GHC's EHR and quality improvement processes, as well as GHC leaders'recognition of gaps in the quality of alcohol- related care, to spread and sustain improvements in alcohol-related care across 25 clinics. Specifically, we will implement SBI and patient-centered care for AUD, reframing AUD management as shared-decision making to help PC teams embrace patient-centered alcohol-related care. Our proposed implementation strategies will build on our previous experience collaborating on implementation of SBI in over 900 clinical sites in the VA and successfully implementing sustained PC innovations in GHC. Impact: We estimate that after full implementation each year: more than 45,000 patients will receive preventive brief alcohol counseling who otherwise would have gone without and more than 1,050 patients would receive care for AUD who would otherwise have gone untreated. In addition, this work will create a roadmap and widely available online tools for other health care organizations needing to improve the quality of alcohol-related care, and will be disseminated in a national summit in Year 4.
Alcohol misuse is the third greatest cause of disability and death in the US, but prevention and treatment of alcohol misuse has not historically been integrated into medical care. The proposed project-by a team including experts in evidence-based care for alcohol misuse, implementation researchers, and clinical leaders in an innovative regional health care system, Group Health Cooperative-will implement sustained evidence-based alcohol-related care in a large regional network of 25 primary care practices.