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Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study.
Singh, Amrita N; Sanchez, Victoria; Kenzie, Erin S; Sullivan, Eliana; McCormack, James L; Hiebert Larson, Jean; Robbins, Alissa; Weekley, Tiffany; Hatch, Brigit A; Dickinson, Caitlin; Elder, Nancy C; Muench, John P; Davis, Melinda M.
  • Singh AN; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Sanchez V; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Kenzie ES; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Sullivan E; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • McCormack JL; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Hiebert Larson J; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Robbins A; Oregon Health Authority Transformation Center, Portland, Oregon, United States of America.
  • Weekley T; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Hatch BA; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Dickinson C; Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Elder NC; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Muench JP; Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America.
  • Davis MM; Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America.
PLoS One ; 17(6): e0269635, 2022.
Article in English | MEDLINE | ID: covidwho-1933342
ABSTRACT

BACKGROUND:

Unhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care.

METHODS:

ANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center-state leaders in Medicaid health system transformation-SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework.

DISCUSSION:

This study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Alcohol Drinking / Ambulatory Care Facilities Type of study: Diagnostic study / Experimental Studies Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0269635

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Alcohol Drinking / Ambulatory Care Facilities Type of study: Diagnostic study / Experimental Studies Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0269635