It’s Time to Ask About Alcohol: Outcomes of an Interprofessional Alcohol Educational Program at Primary Care Offices in Maine

Context: Alcohol is the third-leading preventable cause of death in the United States. Because primary care providers have frequent contact with patients, primary care settings are an ideal site for early detection and secondary prevention for individuals who may be at risk for unhealthy alcohol use or are using alcohol in an unsafe manner. Clinicians report a lack of education and confidence in screening for and treating alcohol use disorder (AUD).

Objective: The Time to Ask (TTA) interprofessional education program provides multimodal programming with practice facilitation, expert consultation and hands-on training to primary care teams to better identify, assess, and treat patients with unhealthy alcohol use.

Study Design and Analysis: A mixed-methods evaluation, using traditional evaluation techniques with rapid cycle feedback.

Setting: 16 primary healthcare settings in Maine, both rural and urban.

Intervention: TTA engages with primary care practices using a multi-pronged approach, including online modules, live continuing medical education, and multi-layered data collection. An interprofessional team also receives practice facilitation support.

Outcome Measures: Administrative data analyzed practice transformation efforts to improve capacity to address AUD. Surveys and interviews gathered feedback on the delivery, content, and impact of modules. Pre-Post assessments of knowledge, attitudes and behavior changes were assessed using the Alcohol and Alcohol Problems Perceptions Questionnaire.

Results: TTA has educated participants from 16 primary care locations across 7 Maine counties. 81% of clinicians report learning new information they could implement immediately. There was a significant increase in learner composite scores in working with people who drink alcohol, including beliefs around legitimacy of roles (pre= 3.24 vs. post, 3.96), perceptions of support for role (3.51, 4.14), self-esteem (3.51, 3.97) and satisfaction (3.13, 3.45). Rates of satisfaction increased from 25 to 66%, comfort 32 to 59%, responsibility 48 to 74%, and working knowledge 59 to 80%. The practice facilitation component had a significant impact on workflows, policies and practices in every practice.

Conclusions: AUD is an under-reported and under-recognized serious medical condition. Providing a multidisciplinary practice facilitation and educational program in primary care practices can increase awareness, confidence, and clinical knowledge to better address this concern.