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Int J Environ Res Public Health. 2017 Sep 8;14(9). pii: E1030. doi: 10.3390/ijerph14091030.

Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care.

Author information

1
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. bobb.j@ghc.org.
2
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. lee.amy@ghc.org.
3
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. lapham.g@ghc.org.
4
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. oliver.m@ghc.org.
5
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. ludman.e@ghc.org.
6
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. achtmeyer.c@ghc.org.
7
Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System 1660 S. Columbian Way, Seattle, WA 98108, USA. achtmeyer.c@ghc.org.
8
Kaiser Permanente Washington, 1200 SW 27th St., Renton, WA 98057, USA. parrish.r@ghc.org.
9
Kaiser Permanente Washington, 1200 SW 27th St., Renton, WA 98057, USA. caldeiro.r@ghc.org.
10
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. lozano.p@ghc.org.
11
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. richards.je@ghc.org.
12
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. Bradley.k@ghc.org.

Abstract

Alcohol use is a major cause of disability and death worldwide. To improve prevention and treatment addressing unhealthy alcohol use, experts recommend that alcohol-related care be integrated into primary care (PC). However, few healthcare systems do so. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). Here, we describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. Across the three sites (N = 74,225 PC patients), alcohol screening increased from 8.9% of patients pre-implementation to 62% post-implementation (p < 0.0001), with a corresponding increase in assessment for alcohol use disorders (AUD) from 1.2 to 75 patients per 10,000 seen (p < 0.0001). Increases were sustained over a year later, with screening at 84.5% and an assessment rate of 81 patients per 10,000 seen across all sites. In addition, there was a 50% increase in the number of new AUD diagnoses (p = 0.0002), and a non-statistically significant 54% increase in treatment within 14 days of new diagnoses (p = 0.083). The pilot informed an ongoing stepped-wedge trial in the remaining 22 PC sites.

KEYWORDS:

alcohol drinking; alcohol use disorders; prevention; primary care

PMID:
28885557
PMCID:
PMC5615567
DOI:
10.3390/ijerph14091030
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

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