Primary Care Intervention Shows Promising Results in Preventing Alcohol Use Disorder
Alcohol use disorder (AUD) is a significant public health issue in the United States, with an estimated 14.1 million adults aged 18 years or older having AUD in 2019. Primary care providers (PCPs) play a crucial role in identifying and managing AUD, but the quality of alcohol-related care in primary care is suboptimal. To address this issue, an implementation intervention was conducted to increase the prevention and treatment engagement for AUD in primary care.
The study was conducted by Amy K. Lee, M.P.H., from the Kaiser Permanente Washington Health Research Institute in Seattle, and colleagues. The trial involved adult patients from 22 primary care practices with visits from January 2015 to July 2018. The implementation intervention included practice facilitation, electronic health record decision support, and performance feedback. The study's co-primary endpoints for prevention and AUD treatment were the proportion of patients with unhealthy alcohol use and brief intervention documented in the electronic health record and the proportion with newly diagnosed AUD and engaged in treatment (brief intervention and AUD treatment engagement, respectively).
A total of 333,596 patients visited primary care during the study period. The proportion of patients with brief intervention was higher during the Sustained Patient-Centered Alcohol-Related Care versus usual care period (57 versus 11 per 10,000 patients/month), while the proportion with AUD treatment engagement did not differ between the periods (1.4 versus 1.8 per 10,000 patients/month). Immediate outcomes of screening, new AUD diagnosis, and treatment initiation all increased significantly with the intervention.
The study's results suggest that the implementation intervention increased prevention but not treatment engagement for AUD in primary care. The authors note that while the increases in brief intervention and AUD treatment initiation were modest, the gaps in the quality of alcohol-related care are significant, and iterative quality improvement efforts will likely be necessary.
Journal Information: Amy K. Lee et al, Integrating Alcohol-Related Prevention and Treatment Into Primary Care, JAMA Internal Medicine (2023). DOI: 10.1001/jamainternmed.2022.7083