title: Initial steps taken by nine primary care practices to implement alcohol screening guidelines with hypertensive patients: the AA-TRIP project.
abstract: Many medical conditions are caused or exacerbated by heavy drinking, necessitating alcohol screening and discussion in primary care practices. This is particularly true of hypertension, the most common primary diagnosis in the United States, which has been linked to the regular consumption of 3 or more standard alcoholic beverages a day. The Accelerating Alcohol Screening-Translating Research into Practice (AA-TRIP) project was designed to improve detection and management of alcohol problems in primary care patients with hypertension. Medical providers are being trained using the Practice Partner Research Network's- Translating Research into Practice (PPRNet-TRIP) quality improvement model. This includes a multi-method intervention (electronic medical records, on-site academic detailing, practice feedback reports and annual network meetings) to help practices increase adherence to clinical guidelines. Qualitative analyses of initial steps taken by nine primary care practices toward the routine implementation of alcohol screening guidelines are presented. Organizational factors and provider and patient characteristics all influenced the method and consistency of alcohol screening and intervention. Perceived time constraints, patient sensitivity to questions about alcohol, and possible stigma associated with a diagnosis of alcoholism were also relevant barriers requiring problem solving.
authors.affiliation: Center for Drug and Alcohol Programs, Medical University of South Carolina, 67 President St, PO Box 250861, Charleston, SC 29425, USA. millerpm@musc.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Miller
authors.forename: Ruth
authors.initials: R
authors.lastname: Stockdell
authors.forename: Lynne
authors.initials: L
authors.lastname: Nemeth
authors.forename: Chris
authors.initials: C
authors.lastname: Feifer
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Andrea
authors.initials: A
authors.lastname: Wessell
authors.forename: Heather
authors.initials: H
authors.lastname: Liszka
authors.forename: Steven
authors.initials: S
authors.lastname: Ornstein
mesh_terms: D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000517:prevention & control; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000517:prevention & control; D008403:Mass Screening; D009740:Nursing Staff; D010353:Patient Education as Topic; D010823:Physician Assistants; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D016312:Treatment Refusal