A Multisite Initiative to Increase the Use of Alcohol Screening and Brief Intervention Through Resident Training and Clinic Systems Changes.

Abstract

Screening and brief intervention (SBI) is a seldom-used evidence-based practice for reducing unhealthy alcohol use among primary care patients. This project assessed the effectiveness of a regional consortium's training efforts in increasing alcohol SBI. Investigators combined alcohol SBI residency training efforts with clinic SBI implementation processes and used chart reviews to assess impact on SBI rates in four residency clinics. Data were derived from a random sample of patient charts collected before (2010; n = 662) and after (2011; n = 656) resident training/clinic implementation. Patient charts were examined for evidence that patients were asked about alcohol use by a validated screening instrument, the screening result (positive or negative), evidence that patients received a brief intervention, prescriptions for medications to assist abstinence, and referrals to alcohol treatment. Chi-square analyses identified differences in pre- and posttraining implementation of SBI practices. Following program implementation, screening with validated instruments increased from 151/662 (22.8%) at baseline to 543/656 (82.8%, P < .01), and identification of unhealthy alcohol use increased from 12/662 (1.8%) to 41/656 (6.3%, P < .01). Performance of brief interventions more than doubled (10/662 [1.5%] versus 24/656 [3.7%], P < .01). There were no increases in the use of medications or referrals to treatment. Resident training combined with clinic implementation efforts can increase the delivery of evidence-based practices such as alcohol SBI in residency clinics.