Successful Integration of Alcohol Use Disorder Treatment into a Primary Care Clinic at a Safety-Net Hospital.

BACKGROUND

While primary care-based alcohol use disorder (AUD) treatment models have shown promise, implementation of these resource-intensive models has been limited. Real-world, resource-conscious experience implementing AUD treatment within primary care is needed.

OBJECTIVE

Evaluate the early implementation of a novel primary care-based AUD clinic (AUDC) to provide accessible AUD treatment in a safety-net health system.

DESIGN

Evaluation study of the implementation of the AUDC using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

PARTICIPANTS

Patients seen in the AUDC, January 2022 to February 2023.

INTERVENTION: Embedded within the primary care clinic of a safety-net health system, the AUDC leverages existing resources to provide streamlined AUD treatment including medication for AUD (MAUD) and linkage to behavioral health (BH).

MAIN MEASURES: Evaluation metrics include reach (individual level participation), effectiveness (patient engagement with MAUD and BH and changes in alcohol use and cravings), adoption (source of referrals), implementation (patient engagement across the AUDC care cascade), and maintenance (alcohol-related hospitalizations before and after AUDC engagement).

KEY

RESULTS

The AUDC reached 54 patients and of those, 38 patients (70%) received MAUD and 29 patients (58%) accepted BH services (implementation). In terms of effectiveness, 36 patients (67%) reported reduced alcohol use and cravings at follow-up. For maintenance, there was a difference in proportion of patients with at least one alcohol-related hospitalization in the 6 months before and after their initial AUDC visit (X2 [df 1, N 54] = 15.4, p < 0.001) with 48.2% having an alcohol-related hospitalization before AUDC engagement compared to 13% following AUDC engagement. The AUDC received 109 referrals (adoption).

CONCLUSION

Evaluation of the AUDC suggests potential positive effects on patient engagement, AUD treatment uptake, and alcohol-related outcomes, including alcohol-related hospitalization. Using a streamlined approach and leveraging existing primary care resources may enable implementing AUD treatment in resource-conscious settings.