IMPROVING THE USE OF EVIDENCE-BASED GUIDELINES FOR ALCOHOL SCREENING AND BRIEF INTERVENTIONS IN AN INTERNAL MEDICINE CLINIC

Excessive alcohol use is a growing public health concern in the United States and a leading preventable cause of death. To reduce the harmful health outcomes associated with alcohol use, the United States Preventive Services Task Force recommends screening adults for unhealthy alcohol use in the primary care setting. In addition, patients who are identified with unhealthy drinking are recommended to receive brief behavioral counseling interventions to support a reduction in alcohol intake. A quality improvement project was developed to improve the use of these evidence-based guidelines in an internal medicine clinic where only older adult patients were routinely screened for alcohol use. Using the Model for Improvement Framework and Plan-Do-Study-Act cycles, a systematic protocol to guide alcohol screening and brief interventions (SBI) for the patients of a nurse practitioner was developed and implemented over nine weeks to improve the use of screening and brief interventions. The protocol was developed based on recommendations from the literature and input from the clinic’s staff. The objective of the project was to screen at least 75% of adult patients, 18 and older, presenting for an annual physical and provide brief interventions to at least 50% of patients with a positive screening score. Throughout the project, 134 adult patients visited the clinic and were eligible for alcohol screening. Of this group, 106 patients, or 79.1%, completed screening and 20 had positive screening scores. Brief interventions were provided to 50% of patients with a positive score. Providing education, reminders, and progress feedback to staff throughout the project was important to achieving the project's aims. This project demonstrated that using an SBI protocol can improve the practice of alcohol screening and brief interventions in a primary care setting. Almost one-fifth of the patients who were screened had positive screening scores, highlighting that SBI can provide essential opportunities to have more conversations with patients about their alcohol use and how to reduce risks for harmful health outcomes.