Between 2015 and 2019, excessive alcohol consumption resulted in over 140,000 deaths and a potential loss of 3.6 million years of life each year in the United States, making it the fourth leading preventable cause of death in the country. Despite these horrifying numbers, only 4%—about 1.4 million people—received treatment for their condition.

A new study recently published in BMC basic careled by the Department of Family Medicine at Indiana University School of Medicine, could lead to better alcohol screening among patients in primary care settings.

“Despite recommendations from the U.S. Preventive Services Task Force, alcohol screenings occur in only 2.6% of primary care visits by adults in the United States,” said Diana Summanwar, MD, assistant professor of clinical family medicine at the IU School of Medicine.

“This study highlights the widely recognized gap between research findings and practice. Barriers include gaps in knowledge regarding drinking limits, brief interventions, local resources and pharmacological treatment.”

The quality improvement study was conducted at the IU Health Family Medicine Residence Clinic from October 2021 to July 2022. Unhealthy alcohol use is defined by:

• Binge drinking: More than three drinks for women or more than four drinks for men on a single occasion.
• Heavy alcohol consumption: More than 7 drinks per week for women or more than 14 drinks per week for men.
• Alcohol use disorder: A condition characterized by the inability to stop or control alcohol use despite negative social, occupational, or health consequences.

The study, which involved 67 clinicians and averaged 2,200 adult visits per month, utilized the IU Center for Health Innovation and Implementation Science’s agile implementation process. Initially, the screening rate was 0% using a validated tool. However, after several cycles of improvement, the rate increased to over 70%, peaked at 90%, and remained at 83%—significantly exceeding the baseline rate.

“We wanted to focus on improving the identification of adults with unhealthy alcohol use and improving early detection and intervention,” Summanwar said. “The process incorporates behavioral economics, complex adaptive systems theory and network science to provide a systems approach to identifying and addressing local health problems.”

Other important aspects of the study were:

• Collaborating with Michigan Sustained Patient Centered Alcohol Related Care to test the effectiveness of practice facilitation and electronic health record support in primary care settings.
• Train providers to identify and treat unhealthy alcohol use and conduct screenings, brief preventive counseling, and referrals for treatment.
• Formation of a volunteer team of physicians, medical assistants, front desk staff and social workers to lead implementation efforts.
• Use of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C for screening.
• Develop an evaluation and termination plan, establish criteria for screening rates and intervention success.

Summanwar said the findings of this study could serve as a model for other health care improvements and underscore the need for increased implementation of evidence-based practices to combat unhealthy alcohol use.