Date Available

4-26-2017

Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne A. Jensen

Clinical Mentor

Dr. Peggy El-Mallakh

Committee Member

Dr. Karen Butler

Abstract

Purpose: The purposes of this practice inquiry project were to examine the effect of the addition of a standardized screening tool (AUDIT-C) within the ambulatory electronic health record (AEHR) and the effect of an education session with primary care providers on documentation of alcohol screening and counseling within the AEHR. Furthermore, provider confidence with Screening, Brief Intervention, and Referral to Treatment (SBIRT) was compared before and after the educational session.

Methods: A quasi-experimental one-group pretest posttest design was utilized via chart review prior to and following the educational intervention for patients seen for an annual wellness exam. Data extracted included any alcohol screening performed as well as any subsequent education in the event of a positive alcohol screen. Provider confidence was assessed via questionnaire utilizing a Likert scale in relation to various SBIRT practices. The questionnaire was administered immediately prior to and 3 months post-intervention.

Results: Assessment of alcohol use with a standardized screening tool increased from 44% to 74%, a statistically significant increase. For those who stated that they did consume alcohol, documentation of frequency of alcohol use improved. Statistically significant increases were noted in the assessment of number of drinks consumed per drinking day and the assessment of binge drinking. Among positive alcohol use screenings, documentation of an additional detailed assessment of use as well as documentation of alcohol use counseling improved. Provider confidence overall improved for general screening practices, but provider confidence decreased for practices specific to alcohol dependent or hazardous alcohol consuming patients.

Conclusion: Alcohol use screening and provider confidence with general screening practices improved after the addition of the AUDIT-C to the AEHR and the training session. This program could serve as a model for adoption of other primary care clinics. Given that provider confidence decreased overall in relation to counseling and intervention for patients who screen positive for hazardous or dependent alcohol use, additional education is necessary on brief intervention and resources for referral.

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