Belmont University Research Symposium (BURS)

Screening for Unhealthy Alcohol Use: Implementation of Screening and Brief Intervention (SBI) in Primary Care using the AUDIT-C

Publication Date

Spring 2024

College

Health Sciences & Nursing, Gordon E. Inman College of

Department

Nursing, School of

BURS Faculty Advisor

Steven Busby

Presentation Type

Poster Presentation

Abstract

Background: In 2021, the NIAAA reported that alcohol use disorder affected 29.5 million Americans. Alcohol Screening and Brief Intervention (SBI) is an evidence-based prevention strategy, recommended by the USPSTF, to reduce alcohol consumption. Unfortunately, less than 50% of patients receive advice from their provider about the harms of excessive alcohol use. This study aimed to implement an effective SBI process in a rural primary care setting utilizing the AUDIT-C tool while addressing known barriers to proper implementation.

Methods: Donabedian's Structure-Process-Outcome (SPO) framework for Quality Assessment guided this quality improvement design. Intervention planning included considerations for how closely the three components are related and affect each other. This project used a mixed methods convergent design to evaluate an intervention designed to increase the use of SBI in a primary care setting. Reviewed data included the rate of screenings, number of positive screenings, and frequency of completed brief interventions.

Interventions: Before implementing the new SBI process, providers and ancillary staff attended an in-person education session. The EMR populated the AUDIT-C screening tool into patient charts that were scheduled for an annual wellness or annual Medicare visit. Brief interventions were to be conducted for patients with a positive screening, nevertheless, the option to complete that step and how to complete the intervention was left to the discretion of each provider. Provider and ancillary staff completed pre- and post-implementation surveys to further assess screening practices and provider perceptions of barriers and facilitators to screening.

Results: The screening rate with AUDIT-C was 78.0% compared to 98.0% with the method utilized before the initiative. However, the overall rate of positive screenings doubled with the use of AUDIT-C. Audited charts did not include documented data to suggest that a brief intervention occurred pre- or post-intervention. Survey responses showed that most providers (54.5%) were only slightly familiar with the USPSTF recommendations for SBI, but the same number also indicated that their role in screening was very important. Most ancillary staff (72.7%) responded that they neither agreed nor disagreed that the use of AUDIT-C increased the time it took to complete their job. Providers reported time and patient-related factors (ex. discomfort and truthfulness) as barriers to screening with AUDIT-C.

Conclusions: The provision of brief intervention as part of SBI continues to face challenges despite an increased identification of patients with unhealthy alcohol use utilizing the AUDIT-C tool. Ensuring that providers have adequate knowledge is an important next step to increase their ability to perform brief intervention with increased frequency. Further studies that offer suggestions for overcoming perceived barriers should help increase the utilization of SBI in primary care.

Keywords: unhealthy alcohol use, alcohol use disorder, alcohol screening, brief intervention, barriers to screening, alcohol-related disease, prevention, quality improvement, primary care

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