Initial Steps Taken by Nine Primary Care Practices to Implement Alcohol Screening Guidelines with Hypertensive Patients

Miller, Peter M.; Stockdell, Ruth; Nemeth, Lynne S.; Feifer, Chris; Jenkins, Ruth G.; Nietert, Paul J.; Wessell, Andrea M.; Liszka, Heather A.; Ornstein, Steven M.

doi:10.1300/j465v27n01_08

Cited by 20 publications

(28 citation statements)

References 14 publications

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“…One of these interventions is the Practice Partner Research Network-Translating Research into Practice (PPRNet-TRIP) model, which combines audit and feedback, practice site visits for academic detailing and participatory planning, and network meetings to share "best practice" approaches (Miller et al, 2006a;Rose et al, 2008). Additional research is needed, however, on the sustainability of such interventions over time and on interventions to increase the use of medications for AUDs in primary care.…”

mentioning

confidence: 99%

Integration and Sustainability of Alcohol Screening, Brief Intervention, and Pharmacotherapy in Primary Care Settings

Ornstein

Miller

Wessell

et al. 2013

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: At-risk drinking and alcohol use disorders are common in primary care and may adversely affect the treatment of patients with diabetes and/or hypertension. The purpose of this article is to report the impact of dissemination of a practice-based quality improvement approach (Practice Partner Research Network-Translating Research into Practice [PPRNet-TRIP]) on alcohol screening, brief intervention for at-risk drinking and alcohol use disorders, and medications for alcohol use disorders in primary care practices. Method: Nineteen primary care practices from 15 states representing 26,005 patients with diabetes and/or hypertension participated in a group-randomized trial (early intervention vs. delayed intervention). The 12-month intervention consisted of practice site visits for academic detailing and participatory planning and network meetings for "best practice" dissemination. Results: At the end of Phase 1, eligible patients in early-intervention practices were signifi cantly more likely than patients in delayed-intervention practices to have been screened (odds ratio [OR] = 3.30, 95% CI [1.15, 9.50]) and more likely to have been provided a brief intervention (OR = 6.58, 95% CI [1.69, 25.7]. At the end of Phase 2, patients in delayedintervention practices were more likely than at the end of Phase 1 to have been screened (OR = 5.18, 95% CI [4.65, 5.76]) and provided a brief intervention (OR = 1.80, 95% CI [1.31, 2.47]). Early-intervention practices maintained their screening and brief intervention performance during Phase 2. Medication for alcohol use disorders was prescribed infrequently. Conclusions: PPRNet-TRIP is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and/or hypertension in primary care settings. (J.

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confidence: 99%

Integration and Sustainability of Alcohol Screening, Brief Intervention, and Pharmacotherapy in Primary Care Settings

Ornstein

Miller

Wessell

et al. 2013

J. Stud. Alcohol Drugs

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“…It seems that by working together they were able to overcome some of the challenges associated with change efforts, such as a lack of leadership, 27 limited organizational support for improvement, 9,12,27,28 the need for ongoing communication, 29 and the limited involvement of all members of a patient care continuum in the quality improvement efforts. 27,30 The learning sessions raised the awareness of both coleaders to the difficulty of making and sustaining change and provided them with tools to address resistance to change in their practices.…”

Section: Discussionmentioning

confidence: 99%

It Takes Two: Using Coleaders to Champion Improvements in Small Primary Care Practices

Gallagher¹,

Nutting²,

Nease³

et al. 2010

The Journal of the American Board of Family Medicine

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Background: Making the kind of improvement changes necessary to move toward a patient-centered medical home will continue to challenge small, independent primary care practices. Here we describe further analysis of a successful program to understand the roles of coleaders of a change management process.Methods: Through an improvement collaborative we trained 2 coleaders (a physician and a non-physician) from 16 small primary care practices to institute depression care improvements. These coleaders participated in 3 learning sessions that provided depression care content as well as skills to implement a change management strategy. Qualitative data were collected by observation during the learning sessions and through in-depth interviews conducted at baseline, between each learning session, at the end of the project, 6 months after the project ended, and, finally, 26 months after the project's end.Results: Interview results with the coleaders affirmed that a team approach is a viable strategy for practice improvement. The 2 coleaders used their complementary skills, relationships, and credibility among the practice staff to implement and sustain practice improvements. In their differing roles, they varied in how they perceived barriers to change and how they assessed their team's progress.Conclusions: Involving both a physician and a non-physician as coleaders enables improvement teams in small primary care practices to make progress both in the clinical content of their work and in the critical change management activities involved with creating a team, managing meetings, and coordinating work between meetings. Using a coleader structure enriches the improvement process, broadens participation in the change process, and helps to sustain these efforts over time.

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“…Many medical conditions are caused or exacerbated by heavy drinking. Hypertension, which is the most common primary diagnosis in the United States, has been linked to regularly drinking three or more alcoholic beverages a day (Miller et al, 2006).…”

Section: Assessmentmentioning

confidence: 99%

Treatment of Anxiety, Depression, and Alcohol Disorders in the Elderly: Social Work Collaboration in Primary Care

Rinfrette

2009

Journal of Evidence-Based Social Work

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Anxiety and depressive disorders and symptoms are quite prevalent in older adults as are alcohol problems. Older adults tend to minimize psychological problems and consider psychological symptoms to be related to physical illness. Engagement of the older adult in mental health/substance abuse treatment has been found to be more successful if it occurs in collaboration with primary care treatment. Collaboration between social workers and physicians appears to be an obvious solution to meeting the needs of elderly persons with mental health and/or substance abuse problems who present for medical concerns in their physician's office.

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Initial Steps Taken by Nine Primary Care Practices to Implement Alcohol Screening Guidelines with Hypertensive Patients

Cited by 20 publications

References 14 publications

Integration and Sustainability of Alcohol Screening, Brief Intervention, and Pharmacotherapy in Primary Care Settings

Integration and Sustainability of Alcohol Screening, Brief Intervention, and Pharmacotherapy in Primary Care Settings

It Takes Two: Using Coleaders to Champion Improvements in Small Primary Care Practices

Treatment of Anxiety, Depression, and Alcohol Disorders in the Elderly: Social Work Collaboration in Primary Care

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