Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center
Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center
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DOI：
10.1186/s13722-017-0100-2
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发表时间：
2017-12-07
影响因子：
3.7
通讯作者：
Cunningham, Chinazo O.
中科院分区：
文献类型：
--
作者：
Bachhuber, Marcus A.;O'Grady, Megan A.;Cunningham, Chinazo O.
背景资料：筛查和简短的干预（SBI）不健康的饮酒还没有被广泛实施，在初级保健的一部分原因是依赖于医生来执行it.Methods：我们实施了一个模型的护理人员提供SBI不健康的饮酒成人患者接受初级保健在学术附属的联邦合格的健康中心在纽约州的布朗克斯。我们的模型包括护理人员筛选所有患者的酒精使用障碍识别测试消费问题（AUDIT-C），如果筛选阳性，提供BI或转介到专业服务。我们开发了一个临床决策支持工具集成到电子健康记录，以指导护理人员和记录SBI规定。为了评估这一模型，我们确定了整体SBI交付给患者和相关因素接收SBI.Results：2013年10月和2014年9月之间，9119独特的成人患者24,285访问。患者主要为女性（67.5%）和西班牙裔/拉丁裔（54.5%）。总体而言，46.2%的患者接受了筛查，每月有19.0-35.8%的合格患者接受筛查。年龄增长（或：0.82 [95%CI 0.80-0.85]，10年增加）、女性（OR：0.83 [95%CI 0.77-0.91]）和慢性疾病如高血压（OR：0.62 [95%CI 0.56-0.70]）和糖尿病（OR：0.66 [95%CI 0.58-0.75]）与接受筛查的几率较低相关。在所有筛选的患者中，225例（5.3%）筛选为阳性，其中122例（54.2%）接受了BI。AUDIT-C评分较高的患者更有可能接受BI（OR：1.24 [95% CI 1.04-1.47]，增加1分），非英语患者接受BI的可能性低于英语患者结论：我们的SBI模型筛选了近一半的符合条件的患者，并为超过一半的筛选阳性患者提供了BI。未来改善SBI交付的努力应侧重于老年人，妇女和慢性疾病患者等群体。
Background: Screening and brief intervention (SBI) for unhealthy drinking has not been widely implemented in primary care partly due to reliance on physicians to perform it.Methods: We implemented a model of nursing staff-delivered SBI for unhealthy drinking for adult patients receiving primary care at an academically-affiliated Federally Qualified Health Center in the Bronx, NY. Our model consisted of nursing staff screening all patients with the alcohol use disorders identification test consumption questions (AUDIT-C) and, if screening positive, providing BI or referral to specialty services. We developed a clinical decision support tool integrated into the electronic health record to guide nursing staff and record SBI provision. To evaluate this model, we determined overall SBI delivery to patients and factors associated with receiving SBI.Results: Between October 2013 and September 2014, 9119 unique adult patients made 24,285 visits. Patients were majority women (67.5%) and Hispanic/Latino (54.5%). Overall, 46.2% were screened, with 19.0-35.8% of eligible patients screened in each month. Increasing age (OR: 0.82 [95% CI 0.80-0.85] for a 10-year increase), female sex (OR: 0.83 [95% CI 0.77-0.91]), and chronic conditions like hypertension (OR: 0.62 [95% CI 0.56-0.70]) and diabetes (OR: 0.66 [95% CI 0.58-0.75]), among others, were associated with a lower odds of being screened. Of all patients screened, 225 (5.3%) screened positive and of those patients, 122 (54.2%) received a BI. Patients with higher AUDIT-C scores were more likely to receive a BI (OR: 1.24 [95% CI 1.04-1.47] for a 1-point increase) and non-English speaking patients were less likely to receive a BI than those who spoke English (OR: 0.42 [95% CI 0.18-0.97]).Conclusions: Our model of SBI resulted in screening of nearly half of all eligible patients and BI provision to over half of those screening positive. Future efforts to improve SBI delivery should focus on groups such as older adults, women, and those with chronic medical conditions.