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

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.

Promoting nurse‐led behaviour change interventions to prevent cardiovascular disease in disadvantaged communities: A scoping review

“…These prevention interventions were often tailored for ethnic and cultural differences, values, beliefs and practices (Connolly et al, 2017 ; Crowley et al, 2013 ; Gary et al, 2009 ; Weiler & Tirrell, 2007 ). For instance, studies featured community healthcare workers (CHWs) with the same ethnicity as patients (Allen et al, 2011 ; Brown et al, 2011 ; El Fakiri et al, 2008 ; Gary et al, 2009 ; Jansen et al, 2007 ), interventions using patients' native language(s) (Choi & Rush, 2012 ; Piñeiro et al, 2020 ) and bilingual nurses (Bachhuber et al, 2017 ; Brown et al, 2011 ; Choi & Rush, 2012 ; Weiler & Tirrell, 2007 ). Traditional beliefs in relation to medical practice were also acknowledged (Choi & Rush, 2012 ), and culturally appropriate foods were recommended (Brown et al, 2011 ; Choi & Rush, 2012 ).…”

“…Included studies also showed that brief interventions can overcome barriers posed by time commitments. Numerous studies outlined brief intervention resources and strategies including clinical decision support tools (Bachhuber et al, 2017 ), brief motivational interviewing techniques (Mertens et al, 2014 ), brief advice interventions (Piñeiro et al, 2020 ) and short questionnaires (Waller et al, 2016 ).…”

Screening, brief intervention, and referral to treatment in medical and integrated care settings.

“…Finally, there are patient-level factors relevant to implementation. Patients may be less likely to receive SBIRT depending on demographics (e.g., age, sex) or presence of other health problems (Bachhuber et al, 2017;Hodgson et al, 2016). Patients may feel stigma or discomfort in disclosing substance use or having it documented in the EHR (McNeely et al, 2018;Rahm et al, 2015;Spear, Shedlin, Gilberti, Fiellin, & McNeely, 2016).…”

“…Even less is known about implementation needs in other settings. Several studies have indicated that there may be important interactions between the patient and provider that affect SBIRT implementation (Bachhuber et al, 2017;Hodgson et al, 2016). The patient perspective has not been well documented in SBIRT studies.…”

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial

“…Previous efforts to implement a CDSS have had an inconsistent impact on sex and gender disparities. Integration of a CDSS into the electronic health record of an internal medicine practice did not result in equitable practice, as female patients were less likely to be screened for alcohol use compared to men, although they were not less likely to receive a brief intervention if they screened positive [51]. Another study found that implementation of a performance measure and clinical decision support tool enhanced sex disparities, such that implementation of the performance measure led to a greater increase in rates of brief intervention for men [24].…”