Virginia Mason Medical Center, Seattle, WA
Identifying and Helping People With Unhealthy Alcohol Use in Primary Care

Background: Alcohol misuse is a spectrum ranging from risky consumption to alcohol use disorder, and approximately 30% of the US population suffers from alcohol misuse. Brief multicontact interventions in primary care are an effective method of decreasing risky alcohol use, but our primary care clinics lack standard work procedures around screening and treatment of alcohol misuse, and reluctance to address this important health issue creates disparities in care. Our aim was to identify patients in primary care with alcohol misuse and provide them with appropriate interventions both in the clinic and in the community.

Methods: Our background research involved surveys of 80 providers and 25 patients, interviews with 8 Alcoholics Anonymous members, and direct observation and timings of 7 visits. A multidisciplinary team conducted 4 PDSA cycles to create a new screening and treatment process. Through chart review, we measured the screening rates at annual wellness visits of 5 providers at 1 clinic site. Twenty charts preintervention and 50 charts after each intervention were audited, with equal numbers from each physician.

Results: Preintervention observation of screening revealed a 0% appropriate screening rate and the absence of a reliable system. Major barriers to screening were patient preference to defer this discussion to the provider (64%), patient fear of judgment, provider frustration with substance use (70%), and provider knowledge deficits (79%). After 4 PDSA cycles over 1 year, screening for alcohol misuse during annual visits increased to 92%.

Conclusion: We implemented a standard process for screening patients in primary care for alcohol misuse and provided targeted treatment options that engage resources in the clinic and the larger community. Multiple PDSA cycles were key to addressing unforeseen barriers and refining our tools and process. After the series of interventions, screening for alcohol misuse increased to 92%. We have extended our standard process to all 8 of our clinic locations. In the future, we hope to assess screening results and patient outcomes.