Amy K. Lee, MPH

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A new alcohol use disorder (AUD) treatment implementation program has yielded some positive results but failed to truly differentiate itself from usual care.¹

A team, led by Amy K. Lee, MPH, Kaiser Permanente Washington Health Research Institute, implemented new interventions aimed at increasing population-based alcohol-related prevention with brief interventions and treatment of alcohol use disorder in primary care settings with a broader program of behavioral health integration.

The Concern Over Alcohol Use

Many individuals partake in unhealthy alcohol use, which can lead to higher rates of morbidity and mortality. However, this is often ignored or neglected in medical settings. It is estimated that 20-25% of adults in the US drink at unhealthy levels and 14% have a current AUD.

“Evidence-based prevention of unhealthy alcohol use includes population-based screening and brief counseling for unhealthy alcohol use (brief intervention) aimed at reducing drinking,” the authors wrote. “Brief interventions are recommended by the US Preventive Services Task Force1 and are ranked one of the highest prevention priorities based on potential improvement in population health.”

A New Program

In the stepped-wedge cluster randomized implementation Sustained Patient-Centered Alcohol-Related Care (SPARC) study, the investigators integrated the new programs at 22 primary care practices in an integrated health system in Washington.

The study included adult patients with primary care visits between January 2015 and July 2018.

The new program included practice facilitation, electronic health record decision support, and performance feedback.

Each of the 22 practice was randomly assigned launched data and placed in 1 of 7 waves, defined by the start of the practice’s intervention period.

The investigators sought coprimary outcomes for prevention and AUD treatment, including the proportion of patients who had unhealthy alcohol use and brief intervention documented in EHR for prevention and the proportion of patients who had newly diagnosed AUD and engaged in AUD treatment.

The team used mixed-effects regression and compared monthly rates of primary and intermediate outcomes, including screening, diagnosis, treatment initiation, for patients who visited primary care during usual care and intervention periods.

The study included 333,596 patients who visited primary care. The mean age of the patient population was 48 years.

The results show the proportion of brief intervention was higher during the SPARC intervention than usual care periods (57 vs 11 per 10 000 patients per month; P < .001).

In addition, the proportion of AUD treatment engagement did not differ between the 2 time periods (1.4 vs 1.8 per 10 000 patients; P = .30), but intervention increased intermediate outcomes, including screening (83.2% vs 20.8%; P < .001), new AUD diagnosis (33.8 vs 28.8 per 10 000; P = .003), and treatment initiation (7.8 vs 6.2 per 10 000; P = .04).

“In this stepped-wedge cluster randomized implementation trial, the SPARC intervention resulted in modest increases in prevention (brief intervention) but not AUD treatment engagement in primary care, despite important increases in screening, new diagnoses, and treatment initiation,” the authors wrote.

References:

Lee AK, Bobb JF, Richards JE, et al. Integrating Alcohol-Related Prevention and Treatment Into Primary Care: A Cluster Randomized Implementation Trial. JAMA Intern Med. 2023;183(4):319–328. doi:10.1001/jamainternmed.2022.7083