title: Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings.
abstract: OBJECTIVE
  At-risk drinking and alcohol use disorders are common in primary care and may adversely affect the treatment of patients with diabetes and/or hypertension. The purpose of this article is to report the impact of dissemination of a practice-based quality improvement approach (Practice Partner Research Network-Translating Research into Practice [PPRNet-TRIP]) on alcohol screening, brief intervention for at-risk drinking and alcohol use disorders, and medications for alcohol use disorders in primary care practices.
  
  
  METHODS
  Nineteen primary care practices from 15 states representing 26,005 patients with diabetes and/or hypertension participated in a group-randomized trial (early intervention vs. delayed intervention). The 12-month intervention consisted of practice site visits for academic detailing and participatory planning and network meetings for "best practice" dissemination.
  
  
  RESULTS
  At the end of Phase 1, eligible patients in early-intervention practices were significantly more likely than patients in delayed-intervention practices to have been screened (odds ratio [OR] = 3.30, 95% CI [1.15, 9.50]) and more likely to have been provided a brief intervention (OR = 6.58, 95% CI [1.69, 25.7]. At the end of Phase 2, patients in delayed-intervention practices were more likely than at the end of Phase 1 to have been screened (OR = 5.18, 95% CI [4.65, 5.76]) and provided a brief intervention (OR = 1.80, 95% CI [1.31, 2.47]). Early-intervention practices maintained their screening and brief intervention performance during Phase 2. Medication for alcohol use disorders was prescribed infrequently.
  
  
  CONCLUSIONS
  PPRNet-TRIP is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and/or hypertension in primary care settings.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. ornstesm@musc.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Ornstein
authors.forename: Peter M
authors.initials: PM
authors.lastname: Miller
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Wessell
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: Lynne S
authors.initials: LS
authors.lastname: Nemeth
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
mesh_terms: D000368:Aged; D000427:Alcohol Deterrents / Q000008:administration & dosage; D000428:Alcohol Drinking / Q000009:adverse effects / Q000517:prevention & control*; D019973:Alcohol-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011614:Psychotherapy, Brief / Q000379:methods; D058996:Quality Improvement; D013997:Time Factors
chemical_list: D000427:Alcohol Deterrents