Alcohol-Related Intervention Increased Screening and Brief Intervention, but not Treatment Engagement, in Primary Care

Screening for unhealthy alcohol use is recommended in primary care, but optimal population-based implementation strategies have not been tested and may not have the expected impact on receipt of brief intervention or engagement in treatment for alcohol use disorder (AUD). Researchers conducted a stepped-wedge cluster randomized trial of an alcohol prevention and treatment intervention that included practice facilitation, electronic health record (EMR) decision support, and performance feedback. They assessed the proportion of patients who had unhealthy alcohol use and brief intervention documented in the EMR, and the proportion of patients with newly diagnosed AUD and EMR documentation of AUD treatment. No patient-reported outcomes were assessed.

• 333,596 primary care patients in 22 clinics had a mean age of 48 years; 58 percent were female and 70 percent were White.
• The proportion with EMR documentation of brief intervention was higher during the intervention period than with usual care (57 versus 11 per 100,000 patients per month).
• The proportion of EMR documentation of AUD treatment engagement was similar during the intervention period and usual care (1.4 versus 1.8 per 100,000 patients per month).
• Intermediate outcomes favored the intervention, including screening rates (83 percent versus 21 percent), new AUD diagnosis (34 versus 29 per 100,000), and AUD treatment initiation (7.8 versus 6.2 per 100,000).

Comments: This intervention resulted in substantial improvements in rates of screening, brief intervention, and AUD evaluation, but only modest gains in documented AUD diagnosis and initiation of treatment. The weakest link in this population-based approach was ongoing engagement in alcohol-related treatment, which did not improve with the intervention, and where innovative approaches are needed. While implementation trials solely using EMR data can provide key insights into gaps in treatment, they lack potentially informative patient-level measures of help-seeking and drinking behavior.

Joseph Merrill, MD, MPH

Reference: Lee AK, Bobb JF, Richards JE, et al. Integrating alcohol-related prevention and treatment Into primary care: a cluster randomized implementation trial. JAMA Intern Med. 2023;183(4):319–328.