Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial)

Area of Science:

• Implementation science
• Primary care
• Alcohol-related disorders

Background:

• Integration of alcohol-related care into primary care is recommended but rarely implemented.
• The Sustained Patient-centered Alcohol-related Care (SPARC) program was developed to address this gap.
• SPARC utilizes electronic health record (EHR) decision support, performance monitoring, and practice coaches to enhance care.

Purpose of the Study:

• To evaluate the SPARC implementation intervention's effectiveness in increasing alcohol screening and brief interventions.
• To assess the intervention's impact on the diagnosis and treatment of alcohol use disorders (AUDs).

Main Methods:

• A pragmatic, cluster-randomized, stepped-wedge trial design was employed across 22 primary care clinics.
• The study included all adult patients visiting the participating clinics between January 1, 2015, and July 31, 2018.
• Primary outcomes measured were the rates of screening, brief interventions, and initiation/engagement in AUD care.

Main Results:

• The study protocol describes the methodology for analyzing the impact of the SPARC intervention.
• Qualitative analyses will identify barriers and facilitators to implementation and necessary adaptations.
• The trial is the first to use an experimental design to test this comprehensive approach to alcohol-related care.

Conclusions:

• The SPARC trial protocol is established to rigorously evaluate an integrated care model for unhealthy alcohol use.
• Findings will inform the broader implementation of evidence-based alcohol-related care in primary care settings.