Study highlights gaps in alcohol use screening and treatment in primary care

Alcohol use not being screened enough at primary care level © New Africa - stock.adobe.com

Between 2015 and 2019, excessive alcohol consumption led to over 140,000 deaths annually in the United States, with 3.6 million years of potential life lost each year, making it the fourth leading cause of preventable death in the country. Despite the severity of this public health issue, only about 4% of those affected—approximately 1.4 million people—received treatment for their condition.

A study in BMC Primary Care, led by faculty from the Indiana University School of Medicine, identifies areas for significant improvements in alcohol use screening within primary care settings. The research, led by Diana Summanwar, M.D., assistant professor of clinical family medicine, underscores the critical need for enhanced screening practices.

“Despite recommendations from the U.S. Preventive Services Task Force, alcohol use screenings occur in only 2.6% of U.S. adult primary care visits,” said Summanwar. “This study emphasizes the widely recognized gap between research evidence and practice, with barriers including knowledge gaps related to drinking limits, brief interventions, local resources, and pharmacological treatment.”

The quality improvement study took place at the IU Health Family Medicine Residency Clinic from October 2021 to July 2022. The study aimed to close the gap between research and practice by improving screening rates for unhealthy alcohol use, defined by the study as:

• Binge drinking: More than three drinks for women or more than four drinks for men on a single occasion.
• Heavy drinking: More than 7 drinks per week for women or more than 14 drinks per week for men.
• Alcohol use disorder: A medical condition marked by an inability to stop or control alcohol use despite negative consequences in social, occupational, or health domains.

Involving 67 clinicians and an average of 2,200 adult visits per month, the study applied the agile implementation process developed by the IU Center for Health Innovation and Implementation Science. The screening rate, which initially stood at 0%, surged to over 70% following multiple improvement cycles, peaking at 90% and stabilizing at 83%—a dramatic improvement from the baseline.

“We wanted to focus on enhancing the identification of adults with unhealthy alcohol use and improve early identification and intervention,” said Summanwar. “The process incorporates behavioral economics, complex adaptive systems theory, and network sciences to provide a systemic approach to identifying and addressing local health care challenges.”

Key components of the study included:

• Collaboration with the Michigan Sustained Patient-Centered Alcohol-Related Care to test the effectiveness of practice facilitation and electronic health record support in primary care settings.
• Training providers on recognizing and treating unhealthy alcohol use, along with implementing screening, brief preventative counseling, and referral to treatment.
• Formation of a volunteer team of physicians, medical assistants, front desk members, and social workers to lead the implementation effort.
• Use of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C for screening.
• Development of an evaluation and termination plan, setting criteria for screening rates and intervention success.

Summanwar said that the findings of this study could serve as a model for other health care improvements, highlighting the urgent need to increase the implementation of evidence-based practices in addressing unhealthy alcohol use across the country.