Practice Facilitation to Promote Evidence-based Screening and Management of Unhealthy Alcohol Use in Primary Care

实践促进促进基于证据的不健康饮酒筛查和管理 初级保健 项目总结 在美国，不健康的饮酒是导致可预防死亡的第三大原因。有证据表明， 筛查不健康饮酒并为危险饮酒者提供简短的行为指导 咨询干预改善健康结果，统称为筛查和短暂干预(SBI)。 对于中度或重度酒精使用障碍(AUD)，药物辅助治疗(MAT)是有效的。尽管 有效性的明确证据，只有13%的初级保健患者使用标准工具进行筛查 患有AUD的成年人中只有6.7%接受了治疗。我们认为，印度国家石油公司和MAT未得到充分利用 由于对初级保健在解决不健康问题中的作用和有效性的误解 酒精和有限的实践资源和基础设施。推动传播和落实 基于证据的战略，以解决整个弗吉尼亚州不健康的酒精使用，我们已经延长了我们的 证据现在合作包括弗吉尼亚联邦大学的成瘾医学专家， 弗吉尼亚州动态护理结果研究网络(ACORN)，我们州的家庭医学住院医师 培训计划和我们州的社区服务委员会。我们提出了一种实践级随机聚类 使用等待列表控制的试验。全州五个地区的125家初级保健诊所，每个诊所都围绕 一个教育支持的驻留地点，将接受实践促进干预，以实施筛查， 咨询，并在干预开始时或延迟6个月治疗不健康的酒精。由已确定的 证据现在是变革的主要驱动力，实践支持将包括实践便利化、教育和培训、 共享学习和最佳实践、筛选和咨询工具包、数据支持和评估 反馈。每个诊所将确定一名临床医生、护士和管理员，以在当地领导工作和 参与学习协作。实践将设计和实施筛查、咨询和治疗 流程和业务变化，根据经验和结论调整其实施战略 来自其他网站。我们将进行混合方法的分析。主要结果将包括增加 对不健康的酒精使用进行筛查，增加提供简短的咨询干预和垫子，以及 减少患者练习后的酒精摄入量可获得练习便利。我们将使用合并的 实施研究框架，以对实践便利化进行编码和评级(例如剂量、模式、覆盖范围)和 实践执行战略(例如，已实施的履行机构和MAT战略和工具)。数据 资料来源将包括实习辅导员现场笔记和访谈、图表回顾、患者调查、临床医生调查、 所有付款人索赔数据和定性访谈。我们将在3个月内对患者进行基线调查， 干预后6个月。对于前一个月就诊的18岁至75岁的患者，我们将 随机抽取60人进行调查。除了我们的内部评估外，我们还将参加外部评估 在整个项目期间，与AHRQ合作开展评价和传播活动。

Practice Facilitation to Promote Evidence-based Screening and Management of Unhealthy Alcohol Use in Primary Care PROJECT SUMMARY Unhealthy alcohol use is the third leading cause of preventable death in the US. Evidence shows that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral counseling interventions improves health outcomes, collectively termed screening and brief intervention (SBI). For moderate or severe alcohol use disorder (AUD), medication assistance therapy (MAT) is effective. Despite clear evidence of effectiveness, only 13% of primary care patients are screened with a standard instrument and only 6.7% of adults with AUD receive treatment. We believe that underutilization of SBI and MAT are driven by both a misunderstanding of the role and effectiveness of primary care in addressing unhealthy alcohol and limited practice resource and infrastructure. To promote the dissemination and implementation of evidence-based strategies to address unhealthy alcohol use throughout Virginia, we have extended our EvidenceNow collaboration to include addiction medicine experts at Virginia Commonwealth University, the Virginia Ambulatory Care Outcomes Research Network (ACORN), our state's family medicine residency training programs, and our state's Community Service Boards. We propose a practice-level cluster randomized trial with wait list control. 125 primary care practices in five regions throughout the state, each centered around a residency site for educational support, will receive a practice facilitation intervention to implement screening, counseling, and treatment for unhealthy alcohol at intervention start or 6-month delay. Guided by the identified EvidenceNow key drivers for change, practice support will include practice facilitation, education and training, shared learning and best practices, screening and counseling toolkits, data support, and assessment with feedback. Each practice will identify a clinician, nurse, and administrator champion to locally lead efforts and participate in learning collaboratives. Practices will design and implement screening, counseling, and treatment processes and operational changes, adapting their implementation strategy based on experiences and findings from other sites. We will conduct a mixed methods analysis. Primary outcomes will include the increase in screening for unhealthy alcohol use, increase in provision of brief counseling interventions and MAT, and reduction in alcohol intake for patients after practices receive practice facilitation. We will use the consolidated framework for implementation research to code and rate practice facilitation (e.g. dose, mode, reach) and practice implementation strategies (e.g. SBI and MAT strategies and tools implemented) on outcomes. Data sources will include practice facilitator field notes and interviews, chart reviews, patient survey, clinician survey, All Payer Claims Data, and qualitative interviews. We will administer the patient survey at baseline, 3 months, and 6 months after the intervention. Among patients age 18 to 75 with an office visit the prior month, we will randomly select 60 to survey. In addition to our internal evaluation, we will participate in the external collaborative evaluation and dissemination activities with AHRQ throughout the project.