Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care: A Cluster Randomized Clinical Trial
Unhealthy alcohol use (UAU) is the fourth most preventable cause of death in the US. The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented. To determine if practice...
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| Veröffentlicht in: | JAMA health forum 2024-08, Vol.5 (8), p.e242371 |
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| creator | Huffstetler, Alison N Villalobos, Gabriela Webel, Ben Rockwell, Michelle S Funk, Adam Sabo, Roy T Epling, John W Brooks, E Marshall Britz, Jacqueline B Bortz, Beth A Svikis, Dace S Arias, Albert J Tran, Ryan Nguyen Krist, Alex H |
| description | Unhealthy alcohol use (UAU) is the fourth most preventable cause of death in the US. The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented.
To determine if practice facilitation improved delivery of the recommended care for UAU compared to usual care.
This practice-level cluster randomized clinical trial was conducted across diverse and representative primary care practices throughout Virginia. A total of 76 primary care practices enrolled between October 2019 and January 2023.
Practices received immediate (intervention) or 6-month delayed (control) practice facilitation, which included tailored educational sessions, workflow management, and tools for addressing UAU.
Outcomes included the increase in recommended screening for UAU, brief interventions, referral for counseling, and medication treatment. Data were collected via medical record review (structured and free text data) and transcripts of practice facilitator sessions and exits interviews.
Of the 76 primary care practices enrolled, 32 were randomized to intervention and 35 to control; 11 789 patients (mean [SD] age, 50.1 [16.3] years; 61.1% women) were randomly selected for analysis, with patient demographics similar to Virginia at large. From baseline to 6 months after intervention, screening with a validated instrument increased from 2.1% (95% CI, 0.5%-8.4%) to 35.5% (95% CI, 11.5%-69.9%) in the intervention group compared to 0.4% (95% CI, 0.1%-1.8%) to 1.4% (95% CI, 0.3%-5.8%) in the control group (P |
| doi_str_mv | 10.1001/jamahealthforum.2024.2371 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11316228</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3090949998</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1908-2e6daf772911d2c13f76b7b2ffa93b6afbfe0c0625b6efcd7b89a0ac810e4dfb3</originalsourceid><addsrcrecordid>eNpdkV1rFDEUhoMottT-BYl4482uJ8luZuKNLItthYJFutfhTD7crJmkJjNC_fXOsLXUXiUkz3nPOTyEvGOwZADs4wF73DuMw97nMvZLDny15KJhL8gpl61aAGvlyyf3E3Je6wEA-Jox2YjX5EQoxqFV61Py86agGYJx9AJNiGHAIeREh0w31hZXK92lY7d7uokm73Oku-poSPSmhB7LPd1icZ_ohm7jWAdX6HdMNvfhj7PTU0jBYKS3JWB8Q155jNWdP5xnZHfx5XZ7tbj-dvl1u7leGKagXXAnLfqm4Yoxyw0TvpFd03HvUYlOou-8AwOSrzvpvLFN1yoENC0Dt7K-E2fk8zH3bux6Z41LQ8Go747z6oxB__-Twl7_yL81Y4JJztsp4cNDQsm_RlcH3YdqXIyYXB6rFqBArZRSM_r-GXrIY0nTfjMlG4A1FxOljpQpudbi_OM0DPSsVT_TqmetetY61b59us5j5T-J4i9eRqUv</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3096700523</pqid></control><display><type>article</type><title>Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care: A Cluster Randomized Clinical Trial</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Huffstetler, Alison N ; Villalobos, Gabriela ; Webel, Ben ; Rockwell, Michelle S ; Funk, Adam ; Sabo, Roy T ; Epling, John W ; Brooks, E Marshall ; Britz, Jacqueline B ; Bortz, Beth A ; Svikis, Dace S ; Arias, Albert J ; Tran, Ryan Nguyen ; Krist, Alex H</creator><creatorcontrib>Huffstetler, Alison N ; Villalobos, Gabriela ; Webel, Ben ; Rockwell, Michelle S ; Funk, Adam ; Sabo, Roy T ; Epling, John W ; Brooks, E Marshall ; Britz, Jacqueline B ; Bortz, Beth A ; Svikis, Dace S ; Arias, Albert J ; Tran, Ryan Nguyen ; Krist, Alex H</creatorcontrib><description>Unhealthy alcohol use (UAU) is the fourth most preventable cause of death in the US. The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented.
To determine if practice facilitation improved delivery of the recommended care for UAU compared to usual care.
This practice-level cluster randomized clinical trial was conducted across diverse and representative primary care practices throughout Virginia. A total of 76 primary care practices enrolled between October 2019 and January 2023.
Practices received immediate (intervention) or 6-month delayed (control) practice facilitation, which included tailored educational sessions, workflow management, and tools for addressing UAU.
Outcomes included the increase in recommended screening for UAU, brief interventions, referral for counseling, and medication treatment. Data were collected via medical record review (structured and free text data) and transcripts of practice facilitator sessions and exits interviews.
Of the 76 primary care practices enrolled, 32 were randomized to intervention and 35 to control; 11 789 patients (mean [SD] age, 50.1 [16.3] years; 61.1% women) were randomly selected for analysis, with patient demographics similar to Virginia at large. From baseline to 6 months after intervention, screening with a validated instrument increased from 2.1% (95% CI, 0.5%-8.4%) to 35.5% (95% CI, 11.5%-69.9%) in the intervention group compared to 0.4% (95% CI, 0.1%-1.8%) to 1.4% (95% CI, 0.3%-5.8%) in the control group (P < .001). Brief office-based interventions for the intervention group increased from 26.2% (95% CI, 14.2%-45.8%) to 62.6% (95% CI, 43.6%-78.3%) vs 45.5% (95% CI, 28.0%-64.1%) to 55.1% (95% CI, 36.5%-72.3%) in the control group (P = .008). Identification of UAU, referral for counseling, and medication treatment had similar changes for both groups. Qualitative analyses of transcripts revealed that few clinicians understood the preventive service prior to practice facilitation, but at the end most felt much more competent and confident with screening and brief intervention for UAU.
This cluster randomized clinical trial demonstrated that practice facilitation can help primary care practices to better implement screening and counseling for UAU into their routine workflow. Effective primary care practice implementation interventions such as this can have a profound effect on the health of communities. Given the number of people that the participating practices care for, this intervention resulted in an additional 114 604 patients being screened annually for UAU who would not have been otherwise.
ClinicalTrials.gov Identifier: NCT04248023.</description><identifier>ISSN: 2689-0186</identifier><identifier>EISSN: 2689-0186</identifier><identifier>DOI: 10.1001/jamahealthforum.2024.2371</identifier><identifier>PMID: 39120895</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Aged ; Alcohol use ; Alcoholism - therapy ; Clinical outcomes ; Clinical trials ; Cluster Analysis ; Comments ; Counseling ; Female ; Health promotion ; Humans ; Intervention ; Male ; Mass Screening ; Medical practices ; Medical records ; Medical screening ; Middle Aged ; Online Only ; Original Investigation ; Primary care ; Primary Health Care ; Virginia - epidemiology</subject><ispartof>JAMA health forum, 2024-08, Vol.5 (8), p.e242371</ispartof><rights>2024. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2024 Huffstetler AN et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1908-2e6daf772911d2c13f76b7b2ffa93b6afbfe0c0625b6efcd7b89a0ac810e4dfb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39120895$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huffstetler, Alison N</creatorcontrib><creatorcontrib>Villalobos, Gabriela</creatorcontrib><creatorcontrib>Webel, Ben</creatorcontrib><creatorcontrib>Rockwell, Michelle S</creatorcontrib><creatorcontrib>Funk, Adam</creatorcontrib><creatorcontrib>Sabo, Roy T</creatorcontrib><creatorcontrib>Epling, John W</creatorcontrib><creatorcontrib>Brooks, E Marshall</creatorcontrib><creatorcontrib>Britz, Jacqueline B</creatorcontrib><creatorcontrib>Bortz, Beth A</creatorcontrib><creatorcontrib>Svikis, Dace S</creatorcontrib><creatorcontrib>Arias, Albert J</creatorcontrib><creatorcontrib>Tran, Ryan Nguyen</creatorcontrib><creatorcontrib>Krist, Alex H</creatorcontrib><title>Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care: A Cluster Randomized Clinical Trial</title><title>JAMA health forum</title><addtitle>JAMA Health Forum</addtitle><description>Unhealthy alcohol use (UAU) is the fourth most preventable cause of death in the US. The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented.
To determine if practice facilitation improved delivery of the recommended care for UAU compared to usual care.
This practice-level cluster randomized clinical trial was conducted across diverse and representative primary care practices throughout Virginia. A total of 76 primary care practices enrolled between October 2019 and January 2023.
Practices received immediate (intervention) or 6-month delayed (control) practice facilitation, which included tailored educational sessions, workflow management, and tools for addressing UAU.
Outcomes included the increase in recommended screening for UAU, brief interventions, referral for counseling, and medication treatment. Data were collected via medical record review (structured and free text data) and transcripts of practice facilitator sessions and exits interviews.
Of the 76 primary care practices enrolled, 32 were randomized to intervention and 35 to control; 11 789 patients (mean [SD] age, 50.1 [16.3] years; 61.1% women) were randomly selected for analysis, with patient demographics similar to Virginia at large. From baseline to 6 months after intervention, screening with a validated instrument increased from 2.1% (95% CI, 0.5%-8.4%) to 35.5% (95% CI, 11.5%-69.9%) in the intervention group compared to 0.4% (95% CI, 0.1%-1.8%) to 1.4% (95% CI, 0.3%-5.8%) in the control group (P < .001). Brief office-based interventions for the intervention group increased from 26.2% (95% CI, 14.2%-45.8%) to 62.6% (95% CI, 43.6%-78.3%) vs 45.5% (95% CI, 28.0%-64.1%) to 55.1% (95% CI, 36.5%-72.3%) in the control group (P = .008). Identification of UAU, referral for counseling, and medication treatment had similar changes for both groups. Qualitative analyses of transcripts revealed that few clinicians understood the preventive service prior to practice facilitation, but at the end most felt much more competent and confident with screening and brief intervention for UAU.
This cluster randomized clinical trial demonstrated that practice facilitation can help primary care practices to better implement screening and counseling for UAU into their routine workflow. Effective primary care practice implementation interventions such as this can have a profound effect on the health of communities. Given the number of people that the participating practices care for, this intervention resulted in an additional 114 604 patients being screened annually for UAU who would not have been otherwise.
ClinicalTrials.gov Identifier: NCT04248023.</description><subject>Adult</subject><subject>Aged</subject><subject>Alcohol use</subject><subject>Alcoholism - therapy</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Cluster Analysis</subject><subject>Comments</subject><subject>Counseling</subject><subject>Female</subject><subject>Health promotion</subject><subject>Humans</subject><subject>Intervention</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Medical practices</subject><subject>Medical records</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Virginia - epidemiology</subject><issn>2689-0186</issn><issn>2689-0186</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkV1rFDEUhoMottT-BYl4482uJ8luZuKNLItthYJFutfhTD7crJmkJjNC_fXOsLXUXiUkz3nPOTyEvGOwZADs4wF73DuMw97nMvZLDny15KJhL8gpl61aAGvlyyf3E3Je6wEA-Jox2YjX5EQoxqFV61Py86agGYJx9AJNiGHAIeREh0w31hZXK92lY7d7uokm73Oku-poSPSmhB7LPd1icZ_ohm7jWAdX6HdMNvfhj7PTU0jBYKS3JWB8Q155jNWdP5xnZHfx5XZ7tbj-dvl1u7leGKagXXAnLfqm4Yoxyw0TvpFd03HvUYlOou-8AwOSrzvpvLFN1yoENC0Dt7K-E2fk8zH3bux6Z41LQ8Go747z6oxB__-Twl7_yL81Y4JJztsp4cNDQsm_RlcH3YdqXIyYXB6rFqBArZRSM_r-GXrIY0nTfjMlG4A1FxOljpQpudbi_OM0DPSsVT_TqmetetY61b59us5j5T-J4i9eRqUv</recordid><startdate>20240802</startdate><enddate>20240802</enddate><creator>Huffstetler, Alison N</creator><creator>Villalobos, Gabriela</creator><creator>Webel, Ben</creator><creator>Rockwell, Michelle S</creator><creator>Funk, Adam</creator><creator>Sabo, Roy T</creator><creator>Epling, John W</creator><creator>Brooks, E Marshall</creator><creator>Britz, Jacqueline B</creator><creator>Bortz, Beth A</creator><creator>Svikis, Dace S</creator><creator>Arias, Albert J</creator><creator>Tran, Ryan Nguyen</creator><creator>Krist, Alex H</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240802</creationdate><title>Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care: A Cluster Randomized Clinical Trial</title><author>Huffstetler, Alison N ; 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The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented.
To determine if practice facilitation improved delivery of the recommended care for UAU compared to usual care.
This practice-level cluster randomized clinical trial was conducted across diverse and representative primary care practices throughout Virginia. A total of 76 primary care practices enrolled between October 2019 and January 2023.
Practices received immediate (intervention) or 6-month delayed (control) practice facilitation, which included tailored educational sessions, workflow management, and tools for addressing UAU.
Outcomes included the increase in recommended screening for UAU, brief interventions, referral for counseling, and medication treatment. Data were collected via medical record review (structured and free text data) and transcripts of practice facilitator sessions and exits interviews.
Of the 76 primary care practices enrolled, 32 were randomized to intervention and 35 to control; 11 789 patients (mean [SD] age, 50.1 [16.3] years; 61.1% women) were randomly selected for analysis, with patient demographics similar to Virginia at large. From baseline to 6 months after intervention, screening with a validated instrument increased from 2.1% (95% CI, 0.5%-8.4%) to 35.5% (95% CI, 11.5%-69.9%) in the intervention group compared to 0.4% (95% CI, 0.1%-1.8%) to 1.4% (95% CI, 0.3%-5.8%) in the control group (P < .001). Brief office-based interventions for the intervention group increased from 26.2% (95% CI, 14.2%-45.8%) to 62.6% (95% CI, 43.6%-78.3%) vs 45.5% (95% CI, 28.0%-64.1%) to 55.1% (95% CI, 36.5%-72.3%) in the control group (P = .008). Identification of UAU, referral for counseling, and medication treatment had similar changes for both groups. Qualitative analyses of transcripts revealed that few clinicians understood the preventive service prior to practice facilitation, but at the end most felt much more competent and confident with screening and brief intervention for UAU.
This cluster randomized clinical trial demonstrated that practice facilitation can help primary care practices to better implement screening and counseling for UAU into their routine workflow. Effective primary care practice implementation interventions such as this can have a profound effect on the health of communities. Given the number of people that the participating practices care for, this intervention resulted in an additional 114 604 patients being screened annually for UAU who would not have been otherwise.
ClinicalTrials.gov Identifier: NCT04248023.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>39120895</pmid><doi>10.1001/jamahealthforum.2024.2371</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Alcohol use Alcoholism - therapy Clinical outcomes Clinical trials Cluster Analysis Comments Counseling Female Health promotion Humans Intervention Male Mass Screening Medical practices Medical records Medical screening Middle Aged Online Only Original Investigation Primary care Primary Health Care Virginia - epidemiology |
| title | Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care: A Cluster Randomized Clinical Trial |
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