Screening and Interventions for Unhealthy Alcohol Use: Logic for Best Practice Alerts

Description

Flow diagrams showing logic used to create electronic health record tools (Best Practice Alerts) to facilitate screening and interventions for unhealthy alcohol use in primary care practices

Artifact Type
Creation Date
Version
0.1
Status
Experimental
True

Artifact Creation and Usage

Contributors

Dan Jonas, Colleen Barclay, Shana Ratner, Julia Tompkins

IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.
Repository Information
Approval Date
Publication Date
Last Review Date
Knowledge Level

Semi-structured text that describes the recommendations for implementation in CDS

Purpose and Usage
Purpose

The logic diagrams are intended to guide practices and health systems in creating electronic health record tools to faciiltate screening and interventions for unhealthy alcohol use in primary care practices

Intended Population

This artifact is intended for use in an adult population aged 18 and older without a history of AUD

Usage

Intended for use by primary care clinical/medical directors in position to implement screening for unhealthy alcohol use

Cautions

PLEASE NOTE: The 2013 evidenced-based source that this artifact was derived from was updated by the USPSTF in 2018. The updated recommendation is available here: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions

Supporting Evidence
Source Description

Based on 2013 USPSTF Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care recommendation

References

Final Recommendation Statement: Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care. U.S. Preventive Services Task Force. May 2013.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care;

Barclay C, Viswanathan M, Ratner S, Tompkins J, Jonas DE. Implementing Evidence-based Screening and Counseling for Unhealthy Alcohol Use with Epic-based Electronic Health Record Tools: A Guide for Clinics and Health Systems, Developed as Part of a Pilot Dissemination Project (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No.290-2015-00011-I.) AHRQ Publication No. 18-EHC020-1-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2018. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHENGAGEALCOHOLGUIDE

Barclay C, Viswanathan M, Jonas DE. Development of a Primary Care Guide for Implementing Evidence-based Screening and Counseling for Unhealthy Alcohol Use with Epic-based Electronic Health Record Tools: A Pilot Dissemination Project. Methods Research Report. (Prepared by RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2015-00011-I). AHRQ Publication No. 18-EHC020-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2018. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHENGAGEALCOHOL

Recommendation

The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse

Strength of Recommendation

Grade B

Quality of Evidence

See full recommendation report 

Artifact Decision Notes

Decision notes are outlined in the attached implementation guide

Artifact Representation
Triggers

The electronic health record tools (best practice alerts [BPAs]) are intended to fire during office visits when a patient is elegible for routine screening for unhealthy alcohol use

Inclusions

Patient age ≥18 years

Exclusions

Previously diagnosed Alcohol Use Disorder (AUD) (History, Problem List, encounter or hospital diagnosis)
OR
Terminal Illness/Hospice Diagnosis (History, Problem List, encounter or hospital diagnosis)

Interventions and Actions

Initial Alcohol Screen BPA:
Nurse administers initial screening questions and enter responses in the Initial Alcohol Screen Flowsheet;
Documents reasons if screening is not performed;
Provides patient with AUDIT form if initial screen is positive


Incomplete Alcohol Screen BPA:
Nurse provides patient with Alcohol Use Disorders Inventory Test before provider starts the visit;
Documents AUDIT results or reasons that AUDIT is not indicated


Alcohol Screen Positive, Brief Intervention or Other intervention Needed BPA:
Provider selects action to: 
a) Open SmartSet (tool for documentation, referrals, orders, and follow up);
b) Add to assessment to Problem list; 
c) Select reason that intervention is delayed or declined

Testing Experience