Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center

Abstract

Background: Screening and brief intervention (SBI) for unhealthy drinking has not been widely implemented in primary care partly due to reliance on physicians to perform it. Methods: We implemented a model of nursing staff-delivered SBI for unhealthy drinking for adult patients receiving primary care at an academically-affiliated Federally Qualified Health Center in the Bronx, NY. Our model consisted of nursing staff screening all patients with the alcohol use disorders identification test consumption questions (AUDIT-C) and, if screening positive, providing BI or referral to specialty services. We developed a clinical decision support tool integrated into the electronic health record to guide nursing staff and record SBI provision. To evaluate this model, we determined overall SBI delivery to patients and factors associated with receiving SBI. Results: Between October 2013 and September 2014, 9119 unique adult patients made 24,285 visits. Patients were majority women (67.5%) and Hispanic/Latino (54.5%). Overall, 46.2% were screened, with 19.0-35.8% of eligible patients screened in each month. Increasing age (OR: 0.82 [95% CI 0.80-0.85] for a 10-year increase), female sex (OR: 0.83 [95% CI 0.77-0.91]), and chronic conditions like hypertension (OR: 0.62 [95% CI 0.56-0.70]) and diabetes (OR: 0.66 [95% CI 0.58-0.75]), among others, were associated with a lower odds of being screened. Of all patients screened, 225 (5.3%) screened positive and of those patients, 122 (54.2%) received a BI. Patients with higher AUDIT-C scores were more likely to receive a BI (OR: 1.24 [95% CI 1.04-1.47] for a 1-point increase) and non-English speaking patients were less likely to receive a BI than those who spoke English (OR: 0.42 [95% CI 0.18-0.97]). Conclusions: Our model of SBI resulted in screening of nearly half of all eligible patients and BI provision to over half of those screening positive. Future efforts to improve SBI delivery should focus on groups such as older adults, women, and those with chronic medical conditions.