The ATTAIN Solution Tested: Initial Pilot Results of an Automated, Web-based Screening Tool for Unhealthy Drinking Behaviors.

BACKGROUND: Automated Alcohol Misuse Interventions (ATTAIN) is an automated, computer-based tool that screens people for unhealthy alcohol use and offers web-based counseling with minimal involvement of health-care personnel. We describe the outcomes of the initial quality improvement pilot tests done to examine the screening component of ATTAIN. METHODS: This is a data-only study that reports the results from the ATTAIN-quality improvement database. A detailed description of the quality improvement methods is presented in a related article. The primary outcome was the ATTAIN questionnaire response rate. Secondary outcomes included the percentage of individuals who screened positive for unhealthy drinking behaviors and for alcohol use disorders, respondents' comfort level with ATTAIN, and the cost of ATTAIN. RESULTS: A total of 301 members were included in the pilot tests. The ATTAIN response rate was 46%. The prevalence of unhealthy drinking behaviors and alcohol use disorders was 16% and 5%, respectively. These rates were noninferior to the Healthcare Effectiveness Data and Information Set 2019 rates submitted from the same organization for the Unhealthy Alcohol Use Screening and Follow-up measure. In the post-ATTAIN paper surveys, 100% agreed to the statement: "I felt comfortable answering [ATTAIN] questions . . . ." The cost of ATTAIN screening was estimated to be one-tenth the cost of office-based screening. CONCLUSION: ATTAIN was well accepted by eligible adults, appeared noninferior to office-based screening, and added several potential advantages in terms of screening for alcohol use disorders and readiness to change.

Unhealthy Drinking Behavior and the ATTAIN Solution: Web-based Automated Alcohol Misuse Interventions.

BACKGROUND: Up to 30% of American adults may have unhealthy drinking behavior, but only 17% get screened. There is promise in improving screening via technology, but there is a lack of published evidence supporting these efforts. We describe the development of Automated Alcohol Misuse Interventions (ATTAIN), an automated, web-based process to screen for and manage adults with unhealthy drinking behavior with minimal involvement of health-care personnel. METHOD: After creating a strategic business plan, ATTAIN was developed for the Southern California Permanente Medical Group using its integrated model of care, electronic medical records, and patient portal. ATTAIN is based on an automated branching questionnaire that screens for unhealthy drinking behavior and, when applicable, alcohol use disorders, and incorporates questions about readiness to change and interest in medications/counseling to assist with alcohol consumption reduction. Health plan members would be invited via email to fill out the screening questionnaire using the patient portal. Based on their responses, they would receive appropriate automated feedback and a link to a counseling video about the spectrum of alcohol use. Patients' responses would be captured in their medical record and sent to a designated provider for further help as needed. The process would be refined through successive quality improvement pilots. We project that ATTAIN will lead to reduced costs for the Southern California Permanente Medical Group . CONCLUSION: This effort has paved the way for using ATTAIN to improve patient care and to reduce the costs associated with managing unhealthy drinking, and potentially leads to similar processes for other medical conditions and health-related behaviors.