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The SPARC intervention modestly increased alcohol use prevention via brief interventions in primary care but did not improve alcohol use disorder treatment engagement. The study highlighted increased screening and diagnosis rates.

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Area of Science:

  • Public Health
  • Implementation Science
  • Primary Care Medicine

Background:

  • Unhealthy alcohol use is a significant contributor to morbidity and mortality.
  • Despite existing guidelines, prevention and treatment of alcohol use disorder (AUD) are often overlooked in medical settings.
  • Integrating behavioral health services is crucial for addressing AUD in primary care.

Purpose of the Study:

  • To evaluate an implementation intervention designed to enhance population-based alcohol-related prevention and AUD treatment within primary care.
  • To test the effectiveness of the Sustained Patient-Centered Alcohol-Related Care (SPARC) program in improving alcohol-related care delivery.
  • To assess the impact of a multi-strategy intervention on brief interventions and AUD treatment engagement.

Main Methods:

  • A stepped-wedge cluster randomized implementation trial involving 22 primary care practices.
  • Intervention strategies included practice facilitation, EHR decision support, and performance feedback.
  • Coprimary outcomes were documented brief interventions for unhealthy alcohol use and AUD treatment engagement, analyzed using mixed-effects regression.

Main Results:

  • The SPARC intervention led to a significant increase in brief interventions for unhealthy alcohol use (57 vs 11 per 10,000 patients/month).
  • No significant difference was observed in AUD treatment engagement between intervention and usual care periods (1.4 vs 1.8 per 10,000 patients).
  • The intervention significantly improved intermediate outcomes, including screening rates (83.2% vs 20.8%), new AUD diagnoses, and treatment initiation.

Conclusions:

  • The SPARC intervention demonstrated modest success in increasing alcohol use prevention through brief interventions in primary care.
  • The intervention did not significantly improve alcohol use disorder treatment engagement despite increases in screening and diagnosis.
  • Further research is needed to optimize AUD treatment delivery within integrated primary care settings.