Prevention of Fetal Alcohol Spectrum Disorders in Primary Care: Use of Office Champions Model to Address Alcohol Use.

Abstract

Alcohol use during pregnancy can cause miscarriage, stillbirth, and fetal alcohol spectrum disorders. Despite no safe level of alcohol consumption during pregnancy, 13.5% of pregnant adults reported drinking, and 5.2% reported binge drinking during 2018-2020. This study aimed to improve alcohol screening and brief intervention (ASBI) practices in primary care settings using the Office Champions Quality Improvement Model. Seventeen family medicine practices participated. Champions led system-level changes, including workflow redesign, staff training, and electronic health record modifications. Chart reviews were conducted at 3 stages (ie, baseline, post-intervention, and sustainability) to assess change in ASBI efforts. A sustainability survey assessed likelihood of continued ASBI efforts after study completion. A total of 2,725 chart reviews were completed. For the first 2 stages 17 practices submitted data, and 14 practices completed the third stage. Alcohol use screening rate increased from 61% to 81% (<i>P</i> <.001) and intervention rates increased from 22% to 67% (<i>P</i> <.001). Identification of pregnancy intention increased from 3% to 66% (<i>P</i> <.001) and use of the Alcohol Use Disorders Identification Test-Consumption tool increased from 3% to 48% (<i>P</i> <.001). Most interventions involved brief counseling and goal setting. Nineteen individual respondents completed the sustainability survey, and most reported confidence in continuing ASBI efforts. The Office Champions Quality Improvement Model enhanced ASBI implementation in primary care settings. System-level integration, validated screening tools, education, and a team-based approach supported improvements in ASBI.