Screening and Management of Unhealthy Alcohol Use in Primary Care: Dissemination and Implementation of PCOR Evidence

点击翻译按钮获取中文摘要

Project Summary/Abstract Background: Unhealthy alcohol use is the third leading cause of preventable deaths in the US and is associated with many societal and health problems. It is a key contributor to recent declines in US life expectancy, especially among middle-aged white Americans and those living in rural areas. Despite the burden of illness and recommendations to screen for unhealthy alcohol use, relatively few people who visit primary care providers in the US are asked about alcohol use or ever discuss alcohol use with a health professional. Practices often lack a formal process for screening and subsequent delivery of appropriate interventions. Objectives: The objectives are (1) to determine if primary care practice facilitation (PF) can achieve rapid dissemination and implementation of evidence-based screening, counseling, and medication assisted therapy (MAT) for unhealthy alcohol use and (2) for practices with slower uptake, to compare whether providing embedded telehealth services accelerates the dissemination and implementation of screening, counseling, and MAT. Methods: STUN Alcohol Use Now is an adaptive randomized, controlled trial to evaluate the effect of primary care PF and providing embedded telehealth services on evidence-based screening, counseling, and MAT in 135 primary care practices with 10 or fewer providers. Each enrolled practice will receive the PF intervention. After 6 months of receiving the PF intervention, practices in the lower 50th percentile (based on performance) will be randomized to continued PF or to embedded telehealth services plus PF for the next 12 months. The PF intervention includes onsite QI facilitation, EHR support, training, and academic detailing. Potential Impact: A successful intervention would significantly reduce the burden of disease from unhealthy alcohol use. The study will produce fundamentally important evidence about the effect of practice facilitation on uptake of evidence-based SBI and MAT for unhealthy alcohol use when delivered on a large scale to small to medium-size primary care practices. It will also generate scientific knowledge about whether embedded telehealth services can improve use of evidence-based screening and interventions for practices with slower uptake. The results of this rigorously conducted evaluation are expected to have a positive impact by supplying AHRQ with the evidence it needs to effectively and efficiently accelerate the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.