Novel Telecare Approach Transforms Care for Alcohol Use

TOPLINE:

A new telephone-based program implemented in a Federally Qualified Health Center (FQHC) demonstrates effectiveness in reducing unhealthy alcohol use among diverse adult patients screened using the Alcohol Use Disorders Identification Test (AUDIT).

METHODOLOGY:

• Researchers implemented a screening and team-based telephonic program within a large FQHC system in Texas in which adult patients were routinely screened using AUDIT-Consumption (AUDIT-C) questions.
• The team-based, telecare-centered program was designed to follow-up positive screening results with full AUDIT assessments and to provide a two-session brief intervention for all patients. Patients with AUDIT scores ≥ 12 received the brief intervention along with a referral for additional support or an assessment for pharmacotherapy prescription.
• The researchers screened 3959 patients between March 2021 and May 2023, of whom 412 patients with positive results were successfully contacted and had their AUDIT completed (mean age, 46 years; 32% women; 86% Hispanic/Latino; 65% preferred Spanish).
• Of these, 29 patients had full AUDIT scores ranging from 0 to 3, 252 had scores between 4 and 12, and 131 had scores > 12.
• Follow-up AUDIT assessments conducted at 3-6 months were completed for 251 patients (26% women; 90% Hispanic/Latino), and those with AUDIT scores ≥ 12 were offered additional treatment options, including telecare services, in-person appointments with the addiction medicine clinic, and/or pharmacotherapy.

TAKEAWAY:

• Among the patients with an initial AUDIT score > 12, 19 received pharmacotherapy and 13 had at least one appointment with the addiction medicine service.
• For patients who completed the initial and final follow-ups, the mean change in AUDIT score was −4.1 (95% CI, −3.4 to −4.7).
• Spanish-speaking patients demonstrated a greater reduction in AUDIT scores than English-speaking patients.
• The mean reduction in the AUDIT score at the 3- to 6-month follow-up was larger in those with initial AUDIT scores > 12 than in those with initial AUDIT scores ≤ 12 (7.99 vs 2.25).

IN PRACTICE:

“Our intervention was delivered outside of traditional office visits and did not disrupt clinic flow or add burden to the practice’s providers, who already face significant challenges in serving this high-needs population,” the authors wrote. “We believe this program offers a template for delivering evidence-based, equitable preventive care for unhealthy alcohol use in a diverse patient population,” they further added.

SOURCE:

The study was led by Michael Pignone, MD, MPH, Department of Medicine, Duke University School of Medicine, Durham, North Carolina. It was published online on December 9, 2024, in the Journal of General Internal Medicine.

LIMITATIONS:

The lack of systematic tracking for the unsuccessful attempts at establishing contact limited the understanding of the variations in screening positivity and the subsequent engagement in the program. Program staffing and constraints in the budget limited the ability to reach all potentially interested participants. The absence of a control group made it difficult to attribute the observed reductions in the AUDIT scores solely to the intervention. The data on follow-up were collected from only 61% participants, raising the possibility that those who were not reached may have had different outcomes than those who were successfully contacted.

DISCLOSURES:

The Cancer Prevention and Research Institute of Texas provided funding for this program. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.