Abstract

Background. Alcohol use is a significant risk factor of disability and death for U.S. adults and one out of every six Veteran seen in primary care (PC) report unhealthy alcohol use. Unhealthy drinking is associated with increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g., pharmacotherapy) for those with alcohol use disorders (AUD). The VA was a pioneer in implementing alcohol screening and BI in PC, yet substantial implementation gaps remain. Approximately 25% of Veterans with unhealthy alcohol use still do not receive BIs and evidence suggests that the quality of BIs is lacking. For those with AUD, BI implementation has not appeared to increase access to recommended services (e.g., referrals) nor reduced barriers to pharmacotherapy. In order to improve the quality and fidelity of alcohol-related care, the current research proposes to use an evidence-based implementation strategy, practice facilitation, at one VA to pilot test whether practice facilitation has the potential to improve quality of PC-based alcohol-related care. Significance/Impact. This research directly addresses one of the largest public health crises of our time, as alcohol kills more people than opioids and is associated with increased risk of suicide. Thus, this work may have far-reaching effects on adverse outcomes experienced by Veterans and is aligned with top HSRD and VA priorities, including increased access to care and suicide prevention. Innovation. The project will use innovative implementation techniques not previously used to improve VA alcohol-related care. Specific Aims. Aim 1 is a qualitative study assessing Veteran and PC stakeholders to understand barriers and facilitators to high-quality alcohol care and use results to refine and hone the practice facilitation intervention. Aim 2 will deliver the practice facilitation intervention in a small PC sample to examine its acceptability and feasibility. Aim 3 is a pilot test of the practice facilitation intervention in the full PC clinic to understand whether practice facilitation improves quality of PC-based alcohol-related care. Methodology. Aim 1 will recruit and interview Veterans with unhealthy alcohol use (n=20-25) and PC stakeholders (N=10-15) to help refine the practice facilitation. Aim 2 will deliver the practice facilitation among a small sample of PC providers and staff (n=5-7) to assess acceptability/feasibility. In Aim 3, PC providers/staff from the full clinic will be invited to participate in the practice facilitation in order to assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes. Implementation/Next Steps. Findings will be presented to local and national operational partners and used to improve evidence-based alcohol-related care nationally across VA PC. Candidate. Dr. Rachel Bachrach is a clinical psychologist and postdoctoral research fellow in the Interprofessional Advanced Fellowship in Addiction Treatment based within the Center for Health Equity Research and Promotion (CHERP), a VA HSR&D Research Center of Excellence. The purpose of this CDA-2 is to facilitate Dr. Bachrach’s transition to an independent HSR&D investigator with a long-term objective of improving evidence-based care for addictive disorders. The short-term objective is to obtain formal training, expert mentorship, and research experience to facilitate a VA HSR&D career focused on improving prevention and intervention efforts within PC for Veterans who screen positive for unhealthy alcohol use. Mentorship will provide focused training on goals relevant for both the current CDA-2 research project and for Dr. Bachrach’s career as an independent scientist, including in-depth training in (1) implementation science; (2) alcohol-related care; (3) qualitative methods for intervention development; and (4) intervention design and evaluation.

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DRA: Substance Use Disorders

DRE: TRL - Applied/Translational, Treatment - Implementation

Keywords: None at this time.

MeSH Terms: None at this time.