Jortberg Bonnie T, Dickinson L Miriam, Fernald Douglas H, Bienstock Andrew, de la Cerda Dionisia, Wiggins Kim, Swenson Carolyn, Halfacre Jennifer, Kirchner Stephanie, Dickinson W Perry
From the University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO (BTJ, LMD, DHF, AB, DC, KW, CS, JH, SK, WPD).
J Am Board Fam Med. 2024 Nov-Dec;37(6):1027-1037. doi: 10.3122/jabfm.2024.240048R1.
Unhealthy alcohol use (UAU) is associated with preventable morbidity and mortality and accounted for more than 140,000 deaths per year in the US during 2015 to 2019. The United States Preventive Services Task Force recommends routine screening for UAU in adults aged 18 years and older and pregnant persons, followed by brief counseling for a positive screening (B recommendation). Primary care clinicians can improve UAU outcomes by universally screening and offering brief counseling. This study aimed to increase screening, brief intervention, medication-assisted treatment (MAT), or referral for treatment (SBI/RT + MAT) in primary care practices.
Cluster-randomized study to investigate 1) the effectiveness of virtual practice facilitation as a method to enhance implementation of SBI/RT + MAT and 2) the potential added benefit of using alcohol use eLearning modules to guide and focus the process and content of virtual practice facilitation.
Sixty-one primary care practices in Colorado enrolled in the study, with 43 primary practices completing the intervention and reporting 9-month data. Results show significant overall improvements in SBI/RT + MAT practice implementation scores from baseline to 9-month follow-up ( < .0001) and no differences between groups. The number of patients screened for UAU and/or Alcohol Use Disorder (AUD), receiving brief intervention, receiving an AUD diagnosis all significantly increased from baseline ( < .0001); and number receiving MAT also significantly increased ( < .0014).
Practice facilitation can assist primary care practices in improving SBI/RT + MAT processes and patient outcomes, with the results providing initial evidence for successful use of virtual practice facilitation.
不健康饮酒与可预防的发病率和死亡率相关，在2015年至2019年期间，美国每年有超过140,000人死于不健康饮酒。美国预防服务工作组建议对18岁及以上的成年人和孕妇进行常规的不健康饮酒筛查，筛查呈阳性后进行简短咨询（B级推荐）。初级保健临床医生可以通过普遍筛查和提供简短咨询来改善不健康饮酒的治疗效果。本研究旨在提高初级保健机构中对不健康饮酒的筛查、简短干预、药物辅助治疗（MAT）或转介治疗（SBI/RT + MAT）。
进行整群随机研究，以调查1）虚拟实践促进作为增强SBI/RT + MAT实施的一种方法的有效性，以及2）使用酒精使用电子学习模块来指导和聚焦虚拟实践促进的过程和内容的潜在附加益处。
科罗拉多州的61家初级保健机构参与了该研究，其中43家初级保健机构完成了干预并报告了9个月的数据。结果显示，从基线到9个月随访期间，SBI/RT + MAT实践实施得分总体有显著改善（<.0001），且组间无差异。接受不健康饮酒和/或酒精使用障碍（AUD）筛查、接受简短干预、被诊断为AUD的患者数量均较基线显著增加（<.0001）；接受MAT的患者数量也显著增加（<.0014）。
实践促进可以帮助初级保健机构改善SBI/RT + MAT流程和患者治疗效果，研究结果为成功使用虚拟实践促进提供了初步证据。
