(60) Alcohol Use in Primary Care: It’s Time to Ask

Background

Alcohol is the 3rd leading preventable cause of death. Routine screening and monitoring of consumption is a cost-effective, population-wide, preventative intervention. Despite this, providers report a lack of education and confidence in alcohol use and treating alcohol use disorder (AUD) when indicated. This lack of confidence prevents regular patient-provider conversations about alcohol, preventing early detection and secondary prevention. Programs that improve clinicians’ knowledge, skills and attitudes, particularly in primary care settings where providers have frequent contact with patients, are critical to bridge this gap.

Program Methods

The Time To Ask (TTA) interprofessional education program was developed by the Lunder-Dineen Health Education Alliance of Maine. TTA provides hands-on training to primary care teams enabling them to identify, assess, and treat patients who may be at risk from unhealthy alcohol use. The program engages with a primary care practice using a multi-pronged approach to facilitate culture change, enhance provider capacity, and provide ongoing organizational and provider support. Teams complete online training modules followed by live continuing medical education (CME) on AUD pharmacotherapy. This work is complemented by monthly onsite support, expert consultation, and multi-layered data collection. Module 1 reviews unhealthy alcohol use, identification criteria, and stigma. Module 2 presents screening techniques and interprofessional care principles/responsibilities. Module 3 covers screening interpretation, alcohol-related risks, AUD care pathways, and recovery support. Upon program completion, the practice receives the educational program bundle and impact findings to support ongoing maintenance. During the poster presentation, attendees will have the opportunity to utilize iPads to explore TTA tools and resources.

Evaluation

Evaluations include administrative data, surveys and focus groups with participants. Administrative data analyzed practice transformation efforts to improve provider’s capacity to address AUD. Surveys and interviews focused on gathering learner feedback on the delivery, content, and impact of the modules. Pre-Post assessments of HCP knowledge gain, attitudes and behavior changes were assessed using the Alcohol and Alcohol Problems Perceptions Questionnaire.

Results

TTA has over 300 participants from 15 primary care locations serving over 39,000 patients across 7 rural Maine counties. Participants indicated the program would change their practice, with 81% of clinicians reporting learning new information that they could implement within the next month. Participants also reported improved attitudes indicating they would change their behavior working with drinkers by screening for unhealthy alcohol use; promoting care team collaboration; and being less stigmatizing and more patient-centered.

There was an increase in learner composite scores on beliefs around the legitimacy of their roles (pre= 3.24 vs. post, 3.96- P=0.003), perceptions of support for their role (3.51, 4.14- P< 0.001), and self-esteem (3.51, 3.97- P< 0.001) and satisfaction (3.13, 3.45- P=0.01) in working with people who drink. The largest changes in individual response items were in provider satisfaction, comfort, identified responsibilities, and working knowledge. Rates of satisfaction doubled from 25% to 66%, comfort increased from 32 to 59%, identified responsibility increased from 48 to 74%, and working knowledge increased from 59 to 80%. HCPs indicated that peer support via expert consultation was a key component. Onsite practice support by Lunder-Dineen played a key role in promoting enhanced SBIRT and the use of medication for AUD.

References

1. Edelman, E. J., Tetrault, J. M., (2018). Unhealthy Alcohol Use in Primary Care -The Elephant in the Examination Room. JAMA Internal Med. doi:10.1001/jamainternmed.2018.6125

2. Kelly, J. F., Wakeman, S. E., & Saitz, R. (2015). Stop talking 'dirty': Clinicians, language, and quality of care for the leading cause of preventable death in the United States. The American Journal of Medicine, 128(1), 8–9. doi:10.1016/j.amjmed.2014.07.043.

3. NIAAA Rethinking Drinking: Alcohol and Your Health retrieved at: https://www.rethinkingdrinking.niaaa.nih.gov/Tools/

4. Gorman DM, Cartwright AK. (1991) Implications of using the composite and short versions of the alcohol and alcohol problems perception questionnaire (AAPPQ). Br J Addict 86:327–34.