Family physicians are in a prime position to address risky alcohol use in adults, particularly women of childbearing age in whom it could lead to fetal alcohol spectrum disorders, and the AAFP is looking for as many as 25 family medicine practices to participate in its new Alcohol Screening and Brief Intervention Office Champions Project.
Applications are due Aug. 31.
Research shows that alcohol SBI, which includes short counseling sessions, feedback, advice and goal-setting conducted by health care professionals, is effective at reducing alcohol misuse among adults, including pregnant women.
Jeffrey Quinlan, M.D., of Alexandria, Va., a member of the AAFP Commission on Health of the Public and Science, told AAFP News that alcohol use disorders are relatively common among adult patients (6.2% of Americans age 18 or older have an AUD, according to data from the 2015 National Survey on Drug Use and Health(www.niaaa.nih.gov)), and binge drinking is even more common (26.9% of adults binge drank within the previous month in the 2015 survey).
"Many practices do not currently screen for AUDs or binge drinking, and, therefore, we are likely missing an opportunity to intervene with many of these patients," Quinlan said. "Participating as champions in this project would afford practices the opportunity to develop practice patterns using an evidence-based prevention approach."
- The AAFP is looking for as many as 25 family medicine practices to participate in its new Alcohol Screening and Brief Intervention Office Champions Project; applications are due Aug. 31.
- Research shows that alcohol SBI, which includes short counseling sessions, feedback, advice and goal-setting conducted by health care professionals, is effective in reducing alcohol misuse among adults, including pregnant women.
- Based on efficacy and cost-effectiveness, alcohol SBI is among the top 10 preventive health services; however, alcohol SBI remains one of the least adopted of these evidence-based services.
Based on efficacy and cost-effectiveness, alcohol SBI is among the National Commission on Prevention Priorities' top 10 preventive health services.(www.annfammed.org) However, alcohol SBI remains one of the least adopted of these evidence-based services.
"I think there are probably a number of factors that contribute to this," said Quinlan. "These include an underestimation of prevalence in practices' patient population, lack of resources, lack of awareness of the evidence-based intervention and time."
"I am hopeful that this project decreases barriers that exist and highlights both the availability of the tool and the effectiveness of the intervention," he added.
Alicia Kowalchuk, D.O., an associate professor at the Baylor College of Medicine in Houston who has extensive experience working with patients with AUDs, told AAFP News that when it comes to screening adults, including pregnant women, for unhealthy alcohol use, alcohol SBI has a "B" recommendation from the U.S. Preventive Services Task Force.(www.uspreventiveservicestaskforce.org) And it also is now considered a National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measure.(www.ncqa.org)
"This project gives participating practices and family physicians the opportunity to implement this important and underutilized health screen with strong support from the AAFP and national experts in alcohol SBI primary care implementation," she said.
Common barriers to providing alcohol SBI include some family physicians' reluctance to ask patients about alcohol use for fear of offending them, Kowalchuk said, yet surveys of patients show that they expect health care professionals to ask about their alcohol use and rarely take offense.
Another barrier is that alcohol SBI requires a systems approach to implementation and rarely works well or is sustainable when the responsibility is solely on the physician.
"A practice champion is key, as is a team approach to the workflow," said Kowalchuk. For example, screening is often initiated during sign-in with front desk personnel. Screening is completed and positive screening results are flagged during the rooming process with medical assistants, and positive screens are addressed with patients (the brief intervention) during the physician visit (or in integrated practices, after the physician visits with the behaviorist), she added.
As for what works best during screening and intervention, Kowalchuk cited three factors:
- avoiding stigmatizing, judgmental language such as "abuse";
- taking a universal approach to screening (i.e., not targeting screening based on a patient's appearance or behavior); and
- focusing on eliciting the patient's reasons for wanting to cut back or stop drinking.
Additional Project Details
The Alcohol SBI Office Champions Project, funded through a cooperative agreement with the CDC, will incorporate the following key steps:
- recruit and train as many as 25 physician and/or practice champions to improve the delivery of alcohol SBI among women ages 18-44;
- lead the charge for reducing rates of risky alcohol use and preventing FASDs;
- integrate alcohol SBI and other system changes into daily office routines; and
- determine whether the new model is effective, successful and sustainable, and eventually will offer a useful and reliable model for all family physicians.
Participating practices will receive as much as $3,000 to cover administrative support associated with the project, pending availability of grant funding, for reaching the following milestones:
- Practices will be awarded $1,000 after the family physician champion and/or office champion attends the educational training conference Nov. 2-3; completes the Collaborative Institutional Training Initiative course, introductory teleconference, project survey and pre-intervention (baseline) chart reviews; and submits a project plan by the end of 2019.
- Practices will be awarded $1,000 after completing the post-intervention chart reviews and participating in the alcohol SBI webinars, to occur around December 2020.
- Practices will be awarded $1,000 after completing sustainability chart reviews (third measurement) and all phases of the project, including a post-project review, to occur around December 2021.
The family physician champion who attends the Nov. 2-3 in-person educational training conference and the in-person educational conference on lessons learned from the project in September 2022 will be reimbursed for travel expenses. The family physician also will have the potential opportunity to present at a local or national meeting. Travel expenses for this in-person meeting will be reimbursed.
Finally, completing this quality improvement project will help family physicians satisfy the American Board of Family Medicine's Family Medicine Certification Performance Improvement activity requirements.
Quinlan said he hopes the Alcohol SBI Office Champions Project heightens family physicians' awareness of both the problem of AUDs and binge drinking and the potential for brief intervention.
"We also hope that they find the available tools easy to implement and continue to use them," he concluded. "If even one to two patients in each participating practice are identified and helped, that would be a success for the practice, the patient and their families/friends."
Again, applications for the AAFP Alcohol SBI Office Champions Project(3 page PDF) are due Aug. 31, so don't delay.
Family physicians who have questions about the project can contact Reshana Peterson, AAFP grant project coordinator, by email or by calling 913-906-6103.
Related AAFP News Coverage
CDC: Prescription Opioid Misuse Linked to Binge Drinking
CDC: Alcohol and Public Health(www.cdc.gov)