Pignone Michael, Calderon-Mora Jessica, Chang Patrick, Labrada Jocelyn, Mendoza Karen, Weems John, Velasquez Mary, Hubley Matt, Young Sara, Kluz Nicole
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.
J Gen Intern Med. 2024 Dec 9. doi: 10.1007/s11606-024-09240-5.
Screening and brief intervention (BI) can reduce risky alcohol use but has not been widely implemented in primary care settings. We sought to implement a screening and telephone-based program within a Federally Qualified Health Center (FQHC).
Prior to this program, adult patients were routinely screened using AUDIT-C with no further systematic follow-up. We designed a team-based, tele-care-centered program to (1) follow-up positive screening results or provider referrals with full AUDIT and (2) provide a social worker-administered two-session BI for patients with AUDIT 4-12; those with high AUDIT scores received BI and were offered pharmacotherapy and/or referral for additional support. Repeat AUDIT was administered at 3-6 months.
From March 2021 to May 2023, 3959 patients were screened using AUDIT-C, with 632 (16%) screening positive. Mean age was 44; 47% identified as female, 58% as Hispanic/Latino; 43% received care through the county-based Medical Access Program (MAP). Men, those with commercial insurance, and English-speakers were more likely to screen positive. Using telephone outreach to direct referrals and to those screening positive, trained counselors successfully administered the full AUDIT to 412 participants. Initial AUDIT scores were ≤ 12 (n = 281, 68.2%) and > 12 (n = 131, 31.8%). Among patients who completed the initial AUDIT, mean age was 46; 32% identified as female, 86% as Hispanic/Latino, and 66% were insured through MAP. Of the 412, 400 (97%) completed one counseling session and 297 (72%) completed two. Of the 131 with initial AUDIT > 12, 19 received pharmacotherapy and 13 had one or more visits with our addiction medicine service. For the 251 patients with AUDIT data at 3-6 months, the mean score change was - 4.1 (95% CI - 3.4, - 4.7). Spanish-speaking patients showed larger decreases than English-speakers; there were no other statistically significant differences.
Screening and telephone-based BI reduces unhealthy alcohol use in diverse adult FQHC patients.
筛查与简短干预（BI）可减少危险饮酒行为，但在初级保健机构中尚未得到广泛实施。我们试图在一家联邦合格健康中心（FQHC）内实施一项基于筛查和电话的项目。
在该项目实施前，成年患者常规使用酒精使用障碍识别测试-消费版（AUDIT-C）进行筛查，且没有进一步的系统随访。我们设计了一个以团队为基础、以远程护理为中心的项目，以（1）对筛查结果呈阳性或由医疗服务提供者转诊的患者进行全面的AUDIT测试随访，以及（2）为AUDIT评分为4 - 12分的患者提供由社会工作者实施的两阶段BI；AUDIT评分高的患者接受BI，并被提供药物治疗和/或转介以获得更多支持。在3 - 6个月时进行重复AUDIT测试。
2021年3月至2023年5月，3959名患者使用AUDIT-C进行了筛查，其中632名（16%）筛查呈阳性。平均年龄为44岁；47%为女性，58%为西班牙裔/拉丁裔；43%通过基于县的医疗救助项目（MAP）接受治疗。男性、有商业保险的患者以及说英语的患者筛查呈阳性的可能性更高。通过电话联系直接转诊患者和筛查呈阳性的患者，经过培训的咨询师成功地对412名参与者进行了全面的AUDIT测试。初始AUDIT评分≤12分的有281名（68.2%），>12分的有131名（31.8%）。在完成初始AUDIT测试的患者中，平均年龄为46岁；32%为女性，86%为西班牙裔/拉丁裔，66%通过MAP参保。在这412名患者中，400名（97%）完成了一次咨询，297名（72%）完成了两次咨询。在初始AUDIT>12分的131名患者中，19名接受了药物治疗，13名接受了我们成瘾医学服务的一次或多次诊治。对于在3 - 6个月时有AUDIT数据的251名患者，平均评分变化为-4.1（95%CI -3.4，-4.7）。说西班牙语的患者评分下降幅度大于说英语的患者；没有其他统计学上的显著差异。
基于筛查和电话的BI可减少不同成年FQHC患者的不健康饮酒行为。
