Abstract
BackgroundScreening and brief intervention (SBI) for unhealthy drinking has not been widely implemented in primary care partly due to reliance on physicians to perform it.MethodsWe 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.ResultsBetween 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]).ConclusionsOur 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.
Highlights
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
The odds of screening increased in each month during the study period (OR: 1.03 [95% confidence intervals (95% CIs) 1.02–1.04])
In a Bronx Federally Qualified Health Center without dedicated grant-funded personnel, we integrated a model of nursing staff-delivered routine SBI for unhealthy drinking into primary care
Summary
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. Bachhuber et al Addict Sci Clin Pract (2017) 12:33 validated screening tools), only 4.4% of those with heavy episodic (i.e., binge) drinking reported being advised to cut back [6]. This gap between evidence and practice is likely the result of several barriers, including competing clinical priorities, staff training and knowledge, and organizational factors [7]. Two implementation trials in primary care settings found that non-physician-delivered SBI resulted in a higher percentage of patients screened than physician-delivered SBI (24 vs 19% and 51 vs 9%) [12, 13]. Both studies revealed that a significant percentage of patients did not receive SBI
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