Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2017

Open Access 01-12-2017 | Research

Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center

Authors: Marcus A. Bachhuber, Megan A. O’Grady, Henry Chung, Charles J. Neighbors, Joseph DeLuca, Elenita M. D’Aloia, Arelis Diaz, Chinazo O. Cunningham

Published in: Addiction Science & Clinical Practice | Issue 1/2017

Login to get access

Abstract

Background

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.

Methods

We 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.

Results

Between 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]).

Conclusions

Our 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.
Literature
1.
2.
Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014;11:E109.CrossRefPubMedPubMedCentral
3.
Kaner EF, Beyer F, Dickinson HO, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;(2):CD004148.
4.
Jonas DE, Garbutt JC, Amick HR, et al. Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2012;157(9):645–54.CrossRefPubMed
5.
Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34(2):143–52.CrossRefPubMed
6.
Glass J, Bohnert K, Brown R. Alcohol screening and intervention among United States adults who attend ambulatory healthcare. J Gen Intern Med. 2016;31:739–45.CrossRefPubMedPubMedCentral
7.
Nilsen P. Brief alcohol intervention—where to from here? challenges remain for research and practice. Addiction. 2010;105(6):954–9.CrossRefPubMed
8.
Aalto M, Pekuri P, Seppa K. Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study. Drug Alcohol Rev. 2003;22(2):169–73.CrossRefPubMed
9.
Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health (Oxf). 2011;33(3):412–21.CrossRef
10.
Rahm AK, Boggs JM, Martin C, et al. Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings. Subst Abus. 2015;36(3):281–8.CrossRefPubMed
11.
Sullivan LE, Tetrault JM, Braithwaite RS, Turner BJ, Fiellin DA. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. Am J Addict. 2011;20(4):343–56.CrossRefPubMed
12.
Babor TE, Higgins-Biddle J, Dauser D, Higgins P, Burleson JA. Alcohol screening and brief intervention in primary care settings: implementation models and predictors. J Stud Alcohol. 2005;66(3):361–8.CrossRefPubMed
13.
Mertens JR, Chi FW, Weisner CM, et al. Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial. Addict Sci Clin Pract. 2015;10:26.CrossRefPubMedPubMedCentral
14.
Harris BR, Yu J. Attitudes, perceptions and practice of alcohol and drug screening, brief intervention and referral to treatment: a case study of New York State primary care physicians and non-physician providers. Public Health. 2016;139:70–8.CrossRefPubMed
15.
Bright TJ, Wong A, Dhurjati R, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012;157(1):29–43.CrossRefPubMed
16.
Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12(10):597–606.PubMed
17.
Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. London: Wiley; 2009.
18.
Salvalaggio G, Dong K, Vandenberghe C, et al. Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians. BMC Health Serv Res. 2013;13:108.CrossRefPubMedPubMedCentral
19.
Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.CrossRefPubMed
20.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMed
21.
National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a Clinician’s guide (updated 2005 edition). Washington, DC: National Institutes of Health, U.S. Department of Health and Human Services; 2005.
22.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.CrossRefPubMed
23.
Williams EC, Johnson ML, Lapham GT, et al. Strategies to implement alcohol screening and brief intervention in primary care settings: a structured literature review. Psychol Addict Behav. 2011;25(2):206–14.CrossRefPubMed
24.
Williams EC, Achtmeyer CE, Thomas RM, et al. Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study. J Gen Intern Med. 2015;30(8):1125–32.CrossRefPubMedPubMedCentral
25.
Ascherio A, Rimm EB, Giovannucci EL, et al. A prospective study of nutritional factors and hypertension among US men. Circulation. 1992;86(5):1475–84.CrossRefPubMed
26.
27.
McFadden CB, Brensinger CM, Berlin JA, Townsend RR. Systematic review of the effect of daily alcohol intake on blood pressure. Am J Hypertens. 2005;18(2 Pt 1):276–86.CrossRefPubMed
28.
Sullivan LE, Fiellin DA, O’Connor PG. The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med. 2005;118(4):330–41.CrossRefPubMed
29.
Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140(3):211–9.CrossRefPubMed
30.
31.
Bradley KA, Lapham GT, Hawkins EJ, et al. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med. 2011;26(3):299–306.CrossRefPubMed
32.
Hawkins EJ, Kivlahan DR, Williams EC, Wright SM, Craig T, Bradley KA. Examining quality issues in alcohol misuse screening. Subst Abus. 2007;28(3):53–65.CrossRefPubMed
33.
Williams EC, Lapham GT, Hawkins EJ, et al. Variation in documented care for unhealthy alcohol consumption across race/ethnicity in the Department of Veterans Affairs Healthcare System. Alcohol Clin Exp Res. 2012;36(9):1614–22.CrossRefPubMed
34.
Rose GL, Badger GJ, Skelly JM, Ferraro TA, MacLean CD, Helzer JE. A randomized controlled trial of IVR-based alcohol brief intervention to promote patient-provider communication in primary care. J Gen Intern Med. 2016;31(9):996–1003.CrossRefPubMedPubMedCentral
35.
Rose GL, MacLean CD, Skelly J, Badger GJ, Ferraro TA, Helzer JE. Interactive voice response technology can deliver alcohol screening and brief intervention in primary care. J Gen Intern Med. 2010;25(4):340–4.CrossRefPubMedPubMedCentral
Metadata
Title
Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center
Authors
Marcus A. Bachhuber
Megan A. O’Grady
Henry Chung
Charles J. Neighbors
Joseph DeLuca
Elenita M. D’Aloia
Arelis Diaz
Chinazo O. Cunningham
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2017
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-017-0100-2

Other articles of this Issue 1/2017

Addiction Science & Clinical Practice 1/2017 Go to the issue

Study protocol

Technology-assisted intervention for parents of adolescents in residential substance use treatment: protocol of an open trial and pilot randomized trial

Research

Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors

Research

A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence

Research

HIV treatment cascade among female entertainment and sex workers in Cambodia: impact of amphetamine use and an HIV prevention program

Research

The association between age of onset of opioid use and comorbidity among opioid dependent patients receiving methadone maintenance therapy

Research

Convenience without disclosure: a formative research study of a proposed integrated methadone and antiretroviral therapy service delivery model in Dar es Salaam, Tanzania