A Behind-the-Scenes Look at Practice Facilitation to Improve Delivery of Unhealthy Alcohol Use Screening and...

In 2019, the Agency for Healthcare Research and Quality (AHRQ) funded 6 grantee teams to evaluate the effectiveness of practice facilitation (PF) as an implementation approach for improving the delivery of U.S. Preventive Services Task Force-recommended unhealthy alcohol use (UAU) services in primary care. This report characterizes practice facilitators' first-hand experiences with implementation.

We invited practice facilitators from each grantee team to participate in group interviews focused on facilitation strategies employed, facilitators and barriers encountered, adaptations made, and practice transformation observed. Interview transcripts were thematically coded using inductive and deductive methods and analyzed using immersion-crystallization.

Seventeen practice facilitators who worked with ~300 practices participated. PF was perceived as effective in overcoming barriers to improve screening and counseling for UAU in varied settings and contexts. Practice-centered strategies that personalized practice engagement, met practices "where they are at," tailored to local context, and fostered deep cultural change were highlighted as instrumental to the multilevel changes needed to transform practice workflow around management of UAU. Facilitator quotes, strategies, and multiple facilitation resources are provided.

Practice facilitators' collective perspectives paint a more complete picture of the processes, adaptations, and outcomes associated with this substantial practice-based research effort. PF is a versatile, flexible, and adaptable implementation approach to improve management of UAU in primary care that provides pragmatic strategies for care teams, practice leaders, researchers, and funders. Practice facilitators' collective perspectives paint a more complete picture of the processes, adaptations, and outcomes associated with this substantial practice-based research effort.