Introduction

Several interventions have shown efficacy in managing unhealthy alcohol use, including screening, motivational interviewing to reduce consumption, and pharmacologic and behavioral interventions for alcohol use disorder (AUD). However, these interventions have not been widely implemented in primary care settings. We aim to reduce unhealthy drinking through implementation of a screening and brief telephone-based intervention program in a Central Texas Federally Qualified Health Centers (FQHC). 

Methods

We developed a quality improvement-based screening and intervention protocol in which patients (age 18+) within a Central Texas FQHC system answer an initial screener, with positive results triggering full AUDIT administration to guide further intervention. Patients with moderate scores (AUDIT 4-12) were offered evidence-based, two-session phone-based brief intervention (BI) with a social work-trained interventionist; those with higher scores could also be referred for pharmacotherapy where warranted. The counseling used motivational interviewing and education around effects of unhealthy alcohol use. Subsequent to intervention, we contacted participants in a three to six month window after initial counseling and administered repeat AUDIT in order to assess change in alcohol use.

Results

Starting in March 2021, 5243 patients were screened using the AUDIT-C, with 328 (6.3%) screening positive. Of these, 208 (63.4%) were contacted and successfully administered a full AUDIT. Within this population, the mean age was 46 years [IQR 36, 58 years]; 28% identified as female and 83% identified as Hispanic/Latino; 61% were insured through the county-based Medical Access Program (MAP), while 5.8% were insured through Medicaid, 7.7% through commercially obtained insurance, and 4.3% through Medicare. Initial AUDIT scores were: 0-4 (n=17, 8.2%), 4-12 (n=116, 55.8%), and > 12 (n=75, 36.1%).

We obtained follow-up AUDIT for 128 of 208 participants (62%). Individuals aged 50 or older or Hispanic/Latino or Non-Hispanic white were more likely to complete 3-6 month follow-up than counterparts. For patients who agreed to complete 3-6 month follow-up, 101 (79%) showed a reduction in AUDIT score, with a mean AUDIT score change of -3.1, 95% CI (-3.7, -2.4).

Conclusion

Screening and brief telephone-based intervention is associated with reduced risky drinking behaviors in diverse adult FQHC patients. Screening and brief intervention provides an opportunity for primary care providers to effectively address risky drinking behaviors in FQHC patients.