Using practice facilitation to improve alcohol-related care in primary care: a mixed-methods pilot study protocol

Area of Science:

• Implementation Science
• Public Health
• Health Services Research

Background:

• Unhealthy alcohol use is a major risk factor for disability, death, and suicide among U.S. adults, particularly Veterans.
• Despite guidelines recommending evidence-based alcohol care in primary care (PC) for Veterans screening positive, significant implementation gaps persist.
• The Veterans Health Administration (VA) has pioneered alcohol screening and brief interventions (BI) but faces challenges in consistent delivery.

Purpose of the Study:

• To pilot a multi-faceted practice facilitation strategy to enhance PC-based alcohol-related care for Veterans.
• To assess the potential of practice facilitation to improve the delivery of evidence-based alcohol interventions within a VA primary care setting.

Main Methods:

• Qualitative interviews with Veterans (n=20-25) and PC stakeholders (N=10-15) to identify barriers and facilitators to high-quality alcohol care.
• Refinement of a practice facilitation intervention guided by the Consolidated Framework for Implementation Research (CFIR).
• Pilot testing of the refined intervention in a PC clinic, evaluating implementation (reach) and effectiveness (reduced drinking) using the RE-AIM framework.

Main Results:

• Qualitative data will inform the refinement of the practice facilitation intervention.
• Focus groups (n=5-7) will assess intervention acceptability and feasibility.
• The pilot will yield data on the implementation and effectiveness of practice facilitation for improving alcohol care.

Conclusions:

• This research addresses the critical public health issue of unhealthy alcohol use and its link to suicide.
• A successful pilot could lead to a scalable intervention to improve care and reduce adverse outcomes for Veterans.
• The study aims to enhance access to care and support suicide prevention efforts among Veterans with unhealthy alcohol use.