October 26, 2022, 9:00 a.m. News Staff — A four-year project to help family physicians increase alcohol screening and brief interventions as routine patient care has produced several tools that members can use in practice right away.
The project, which the AAFP started in 2018 with funding from the CDC, had two objectives: decreasing alcohol use among women of reproductive age and improving health outcomes.
The Academy developed the new tools through work with five other organizations, as well as with 14 practices around the country that used an Office Champions Quality Improvement Model to encourage alcohol screening and brief intervention.
“Our hope is that the ASBI resources will empower family physicians to routinely screen their patients for alcohol misuse by providing easy-to-use resources and reducing barriers to ASBI implementation,” said John Merrill-Steskal, M.D., a family physician at Kittitas Valley Healthcare in Ellensburg, Wash., who served as a technical expert on the project.
The first resource produced for members, Incorporating Alcohol Screening and Brief Intervention Into Practice, appeared as a supplement in the November/December 2020 issue of FPM, and offered guidance on selecting screening tests, establishing practice workflows, and coding and billing.
Throughout the course of the project, the Academy made substantial additions to its Alcohol Misuse webpage including a series of micro-learnings to help family physicians incorporate ASBI into their practices and a link to a CDC training program designed to help clinicians prevent fetal alcohol spectrum disorders.
Now that the ASBI project is complete, its findings have been added to the Alcohol Misuse webpage, as have additional tools for members. The latest resources include a second supplement published in the July/August 2022 issue of FPM, a summary of project outcomes and a presentation of results.
“The resources provided will enable family physicians to incorporate and implement screening and provide brief intervention in their clinical practice,” said Hemalatha Senthilkumar, M.D., an associate director of the family medicine inpatient service at MetroHealth Medical Center in Cleveland, Ohio, an assistant professor at Case Western Reserve University School of Medicine and a co-author of the 2022 FPM supplement. “In practices already doing this, the resources will enhance screening rates.”
The new FPM supplement describes the effects of ASBI and the Office Champions model on patient care. According to the supplement authors, the project showed the value of using validated tools such as the Single-Item Alcohol Screening Questionnaire and the Alcohol Use Disorders Identification Test-Consumption to assist clinicians in discussing alcohol use with patients and helping them make healthier lifestyle choices. The project also showed that screening could be performed by any clinician after receiving proper training.
The outcomes summary compiles data from more than 2,700 patient charts at three intervals. Analysis indicates that from baseline to endpoint, there were overall increases in the number of patients screened for risky alcohol use, the number who screened positive, and the number provided with a brief intervention.
The presentation uses more than two dozen charts and infographics to provide detailed project results taken at baseline and two additional intervals. The presentation includes information on patient and practice characteristics, the types of screening tools used, the types of interventions provided, and other data.
Senthilkumar told AAFP News that the new resources will educate and raise awareness among family physicians on alcohol misuse while encouraging them to implement screenings in their practices.
“Screening for excessive alcohol use is inconsistent and prone to bias,” Senthilkumar said. “By the time a patient is diagnosed with alcohol use disorder, damage has already been done to the patient, affecting both physical and psychological health and, also, socioeconomically. Patients are often not identified with issues related to alcohol use until late. Systematic screening will help identify patients who need intervention early so they can be offered appropriate help.”
Merrill-Steskal cited the 2020 intervention manual as an excellent resource to help family physicians add alcohol screening to their practices, noting the manual’s concise outline of the ASBI process and workflow considerations.
“I encourage family physicians to consider how best to implement ASBI in their clinical workflows,” said Merrill-Steskal. “Reducing risky alcohol use is a highly rewarding and important intervention to improve the health of patients. In addition, performing a brief intervention is a creative, valuable clinical skill that enriches a family physician’s practice while strengthening the physician-patient relationship.”
Senthilkumar added that the AAFP may work with the American Board of Family Medicine to explore incorporating ASBI screening into residency education, and that continued funding could be used to help promote existing resources. Merrill-Steskal, meanwhile, said that while other resources may appear in the future, the tools currently available are “robust “in their ability to help FPs implement ASBI into their practices.
Additional CME and performance improvement activities are expected to be developed and made available to members in 2023.