Evaluation of a Screening and Counseling Tool for Alcohol Misuse: A Virginia Practice Support and Research Network (VaPSRN) Trial

Abstract

Surveys reveal limited screening and counseling for alcohol misuse by primary care physicians despite evidence-based recommendations. We developed and evaluated an alcohol screening and misuse counseling tool designed to assist clinicians at the point of care (POC). This was a mixed methods, prospective cohort study conducted with licensed clinicians in a practice-based research network. A software tool was designed to guide clinicians through evidence-based alcohol misuse assessment and interventions. Participants (N = 12) used the tool an average of 3 sessions and 71% were satisfied with the tool. Participants increased their ability to differentiate between patients who are "at risk" drinkers versus those with alcohol use disorders including dependence/abuse (21%; t = 2.4; P = .04). Thematic analysis of interviews suggests that barriers to overall use included perceptions of alcohol use; clinical need to intervene; time; and issues with use of technology, most often at the POC. However, the tool added confidence and a valuable framework for interventions and was valued as an educational tool. Users felt that increased training and practice could increase comfort and impact future POC use. Increased POC usability also may be achieved through simplification of the tool and additional flexibility in options for POC use. A computer-assisted counseling tool for alcohol misuse and abuse can be implemented in primary care settings and shows promise for improving physician screening and interventions for alcohol misuse. To enhance utility in daily clinical practice we recommend design enhancements and strategies to enhance usage as described in this research.