Strategies to implement alcohol screening and brief intervention in primary care settings: A structured literature review.

Abstract

Although alcohol screening and brief intervention (SBI) reduces drinking in primary care patients with unhealthy alcohol use, incorporating SBI into clinical settings has been challenging. We systematically reviewed the literature on implementation studies of alcohol SBI using a broad conceptual model of implementation, the Consolidated Framework for Implementation Research (CFIR), to identify domains addressed by programs that achieved high rates of screening and/or brief intervention (BI). Seventeen articles from 8 implementation programs were included; studies were conducted in 9 countries and represented 533,903 patients (127,304 patients screened), 2,001 providers, and 1,805 clinics. Rates of SBI varied across articles (2-93% for screening and 0.9-73.1% for BI). Implementation programs described use of 7-25 of the 39 CFIR elements. Most programs used strategies that spanned all 5 domains of the CFIR with varying emphases on particular domains and sub-domains. Comparison of SBI rates was limited by most studies' being conducted by 2 implementation programs and by different outcome measures, scopes, and durations. However, one implementation program reported a high rate of screening relative to other programs (93%) and could be distinguished by its use of strategies that related to the Inner Setting, Outer Setting, and Process of Implementation domains of the CFIR. Future studies could assess whether focusing on Inner Setting, Outer Setting, and Process of Implementation elements of the CFIR during implementation is associated with successful implementation of alcohol screening, as well as which elements may be associated with successful, sustained implementation of BI.

Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural–Urban Variations

“…Despite guidelines from the US Preventive Services Task Force recommending alcohol screening to identify patients who may benefit from brief intervention 27 and the passage of reimbursement for screening and brief intervention by Medicare, most health care organizations have not implemented alcohol or drug use screening in routine care. 28 In this program, state guidelines suggest routine screening of all new patients in the program, and screening rates are close to those reported from Veterans Administration primary care settings 29 . More than a quarter of patients, however, were not screened.…”

Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders

“…Alcohol misuse counseling, including screening and brief intervention, is constrained by barriers, such as inadequate funding, time, and trained personnel (6)(7)(8). In addition, the efficacy of screening and brief intervention in settings other than primary care is not established (9).…”

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

“…[1][2][3] While together screening and brief intervention are considered a top prevention priority for U.S. adults, 4,5 they have proven challenging to implement in routine care. [5][6][7][8] The U.S. Veterans Health Administration (VA) has achieved high rates of documented alcohol screening, both overall 9,10 and relative to other healthcare systems. 6 As a result, the VA has been highlighted as a leader in implementation of alcohol screening.…”

“…[5][6][7][8] The U.S. Veterans Health Administration (VA) has achieved high rates of documented alcohol screening, both overall 9,10 and relative to other healthcare systems. 6 As a result, the VA has been highlighted as a leader in implementation of alcohol screening. 11 Consistent with implementation of other clinical services, 12,13 the VA used a combination of a national performance measure and an electronic clinical reminder to implement alcohol screening.…”