Using Alcohol Screening and Brief Intervention to Address Patients' Risky Drinking

 

Asking patients about their drinking habits is a straightforward way to boost health and revenue.

Fam Pract Manag. 2017 May-June;24(3):12-16.

Excessive alcohol use is far from an isolated problem. Only four percent of the U.S. population meets the diagnostic criteria of having an alcohol use disorder, but almost one in three U.S. adults falls into the “risky” drinking category, and 38 million U.S. adults “binge drink” each year (defined as drinking more than four drinks for women and five drinks for men within a two-hour period).1,2

Most of these drinkers are unaware of the dangers, and many probably consider themselves merely “social” drinkers. However, risky alcohol use can lead to motor vehicle crashes, arrest, intimate partner violence, and medical problems including hypertension, gastritis, liver disease, and cancer.3 Moreover, if a woman drinks while pregnant, the child may be born with a fetal alcohol spectrum disorder, causing lifelong developmental and intellectual disabilities.

As a family physician, you can efficiently and productively address risky drinking with the many patients in your practice who are affected by it. Alcohol screening and brief intervention (aSBI) has been shown to reduce risky drinking and is similar to the blood pressure or tobacco screening you likely already perform in your available for payment. This article describes three steps to seamlessly implement aSBI into your practice:

1) Establish a practice workflow,

2) Incorporate aSBI prompts into your electronic health record (EHR) system,

3) Ensure appropriate coding to receive payment.

VIDEO: BRIEF ALCOHOL INTERVENTION

Alicia Kowalchuk, DO, discusses incorporating alcohol screening into patient visits and demonstrates a brief intervention.


Copyright © 2017 Alicia Kowalchuk, DO

Adding aSBI to the practice workflow

Every practice is unique, so implementing aSBI can be handled in multiple ways. Nevertheless, there are several guiding principles.

First, it is important to identify a practice champion that will promote the use of aSBI within the practice. This person plays a crucial role both as a content resource related to aSBI techniques and as a role model and advocate for maintaining enthusiasm and sustainability within the office. The practice champion will also help identify and overcome any barriers that might get in the way of implementing or sustaining aSBI.

Next, evaluate the current patient flow in the practice. Successful implementations naturally integrate aSBI into practice.1 Moreover, aSBI is considered a grade B recommended service by the American Academy of Family Physicians and the U.S. Preventive Services Task Force and is currently a proposed measure for the 2018 Healthcare Effectiveness Data and Information Set (HEDIS).4,5,6

Using a validated screening

About the Authors

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Dr. Zoorob is chairman and a professor at the Baylor College of Medicine's Department of Family and Community Medicine in Houston....

R. John Grubb is a senior project manager at Baylor's Department of Family and Community Medicine.

Sandra Gonzalez is an instructor at Baylor's Department of Family and Community Medicine.

Dr. Kowalchuk is an assistant professor at Baylor's Department of Family and Community Medicine.

The authors wish to acknowledge Joan Newell for her graphics contributions.

Author disclosures: The authors' work was supported by Centers for Disease Control and Prevention cooperative agreement CDC-RFA-DD14-1402, Fetal Alcohol Spectrum Disorders Practice and Implementation Centers. The contents of the article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the U.S. Department of Health & Human Services. No other relevant financial affiliations disclosed.

 

References

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1. CDC's alcohol screening and brief intervention efforts. Centers for Disease Control and Prevention website. https://www.cdc.gov/ncbddd/fasd/alcohol-screening.html. Updated March 22, 2017. Accessed January 27, 2017....

2. Drinking levels defined. National Institute on Alcohol Abuse and Alcoholism website. http://bit.ly/1X0hFXT. Accessed March 16, 2017.

3. Fact sheets – alcohol use and your health. Centers for Disease Control and Prevention website. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm. Updated July 25, 2016. Accessed January 27, 2017.

4. Clinical preventive service recommendation: alcohol misuse. American Academy of Family Physicians website. http://bit.ly/2nbwrA4. Published 2013. Accessed January 27, 2017.

5. Alcohol misuse: screening and behavioral counseling interventions in primary care. U.S. Preventive Services Task Force website. http://bit.ly/2jGdAqX. Published May 2013. Accessed January 27, 2017.

6. Proposed new measure for HEDIS 2018: unhealthy alcohol use screening and follow-up (ASF). National Committee for Quality Assurance website. http://www.ncqa.org. Published 2017. Accessed March 16, 2017.

7. Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test [published correction appears in J Gen Intern Med. 2010;25(4):375]. J Gen Intern Med. 2009;24(7):783–788.

8. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. 2nd ed. Geneva, Switzerland: World Health Organization; 2001.

9. Centers for Disease Control and Prevention. Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices. Atlanta, GA: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities; 2014.

10. EHR modification. IndianaSBIRT website. http://www.indianasbirt.org/ehr-modification. Accessed January 27, 2017.

11. Tindol GA, Gonzales K, Sedarati K, Smith C. Incorporating validated alcohol and drug screening instruments in the electronic health record. Addict Sci Clin Pract. 2015;10(Suppl 2):O47.

12. Preventive services covered under the Affordable Care Act. U.S. Department of Health & Human Services website. https://www.hhs.gov/healthcare/about-the-aca/preventive-care/index.html. Updated February 1, 2017. Accessed April 5, 2017.

13. Cohrs J. Understanding coding & reimbursement for SBI. Wisconsin Medical Society. Madison, Wis. 2013.

14. Your Medicare coverage: alcohol misuse screening & counseling. Medicare.gov website. https://www.medicare.gov/coverage/alcohol-counseling.html. Accessed January 27. 2017.

15. Screening and counseling to reduce alcohol misuse. Centers for Medicare & Medicaid Services website. http://go.cms.gov/2k1CWAp. Published April 2, 2015. Accessed Jan. 27, 2107.

16. Gates A, Ranji U, Snyder L. Coverage of Preventive Services for Adults in Medicaid. Menlo Park, CA: Kaiser Family Foundation, 2014. http://kaiserf.am/2nYlGhF. Accessed January 27, 2017.

17. Reimbursement for SBIRT. SAMHSA-HRSA Center for Integrated Health Solutions website. http://www.integration.samhsa.gov/sbirt/reimbursement_for_sbirt.pdf. Published November 30, 2012. Accessed January 27, 2017.

 
 

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