Improving Care for Unhealthy Alcohol Use: Results from the Facilitating Alcohol Screening and Treatment (FAST) Colorado Study.

Abstract

Unhealthy alcohol use (UAU) is associated with preventable morbidity and mortality and accounted for more than 140,000 deaths per year in the US during 2015 to 2019. The United States Preventive Services Task Force recommends routine screening for UAU in adults aged 18 years and older and pregnant persons, followed by brief counseling for a positive screening (B recommendation). Primary care clinicians can improve UAU outcomes by universally screening and offering brief counseling. This study aimed to increase screening, brief intervention, medication-assisted treatment (MAT), or referral for treatment (SBI/RT + MAT) in primary care practices. Cluster-randomized study to investigate 1) the effectiveness of virtual practice facilitation as a method to enhance implementation of SBI/RT + MAT and 2) the potential added benefit of using alcohol use eLearning modules to guide and focus the process and content of virtual practice facilitation. Sixty-one primary care practices in Colorado enrolled in the study, with 43 primary practices completing the intervention and reporting 9-month data. Results show significant overall improvements in SBI/RT + MAT practice implementation scores from baseline to 9-month follow-up (<i>P</i> < .0001) and no differences between groups. The number of patients screened for UAU and/or Alcohol Use Disorder (AUD), receiving brief intervention, receiving an AUD diagnosis all significantly increased from baseline (<i>P</i> < .0001); and number receiving MAT also significantly increased (<i>P</i> < .0014). Practice facilitation can assist primary care practices in improving SBI/RT + MAT processes and patient outcomes, with the results providing initial evidence for successful use of virtual practice facilitation.