Facilitating Alcohol Screening and Treatment (FAST)
Condition: Alcohol Use Disorder
MeSH terms: Alcoholism
Study type: Interventional

Summary: 
      Alcohol use is the third leading cause of death in the United States. Primary care practices
      need to implement new research findings that help identify and treat alcohol use disorder.
      This project will compare two methods of supporting small and medium size primary care
      practices in Colorado and surrounding states to improve their alcohol screening and
      treatment.
    

Detailed description: 
      Alcohol use causes an estimated 88,000 deaths yearly and is the third leading cause of
      mortality in the U.S. Unhealthy alcohol use, a spectrum from risky drinking to alcohol use
      disorder (AUD), impacts 27% of adults, with high cost to the health care system.
      Evidence-based guidelines exist for identification and treatment of unhealthy alcohol use,
      and evidence supports the effectiveness of medication-assisted therapy (MAT). Primary care is
      recognized as an ideal context for the implementation of screening and treatment processes.
      Despite the evidence, significant gaps exist in uptake into practice.

      Practice facilitation has emerged as a key method for assisting practices in implementing
      organizational changes and improvements. However, in-person practice facilitation is
      time-intensive and costly, and virtual facilitation has not been as effective as in-person.
      E-learning modules can provide a structure for quality improvement in a clinical area. A
      pilot using e-learning combined with virtual practice facilitation was very successful from
      the perspectives of both practice facilitators and practices. We believe that virtual
      practice facilitation using e-learning modules to focus the content and process has great
      potential as a less costly and equally effective method compared to in-person facilitation.

      In this "Facilitating Alcohol Screening and Treatment (FAST) Colorado" proposal, we will
      perform a cluster randomized trial to examine the Reach, Effectiveness, Adoption,
      Implementation, Maintenance (RE-AIM) and relative value of two approaches to supporting
      primary care practices to implement PCOR findings to improve their identification and
      treatment management of unhealthy alcohol use among adults, including screening, brief
      intervention, medication assisted therapy, and referral to treatment. This trial will
      investigate the superiority from an effectiveness perspective of: a) a virtual practice
      facilitation intervention, with a practice facilitator working with practices in virtual
      one-on-one or group sessions utilizing alcohol use e-learning modules to guide and focus the
      process and content, compared to b) a virtual practice facilitation intervention, with a
      practice facilitator working with practices in virtual one-on-one or group sessions without
      utilizing alcohol use e-learning modules. We will identify key practice characteristics and
      other contextual factors that impact the response of practices to the two practice
      interventions. We will compare the adaptability, trialability, and scalability of the two
      interventions in order to plan dissemination of the findings to key local, regional, and
      national stakeholders, including sharing ongoing lessons learned and resources with other
      programs supporting practice transformation.
    

Intervention name(s): Virtual Practice Facilitation with e-Learning; Virtual Practice Facilitation without e-Learning
Intervention type(s): Other; Other
Intervention description(s): Virtual practice facilitation intervention using e-learning modules to guide the sessions includes:
a. Practice Facilitator (PF) conducts 7 monthly virtual visits with each practice QI team i. Optional: PFs and practices may choose to conduct virtual facilitation in groups of up to 5 practices simultaneously b. MAT training (combination of virtual academic detailing plus online training resource) plus ongoing support to deal with questions through email and/or office hours with our project staff, experts, with additional consultation if needed with an addiction medicine specialist.
c. Resources largely included as part of the e-learning module, but supplemented by online resource hub d. Centralized remote health information technology assistance, focused on implementation of registry functionality to track patients for population management and to report the measures required by AHRQ.; Virtual practice facilitation intervention without e-learning to guide the sessions includes:
a. Practice Facilitator (PF) conducts 7 monthly virtual visits with each practice QI team i. Optional: PFs and practices may choose to conduct virtual facilitation in groups of up to 5 practices simultaneously b. MAT training (virtual academic detailing) plus ongoing support to deal with questions through email and/or office hours with our project staff, experts, with additional consultation if needed with an addiction medicine specialist c. Online resource hub d. Centralized remote health information technology assistance, focused on implementation of registry functionality to track patients for population management and to report the measures required by AHRQ.
Other intervention name(s): Virtual practice facilitation intervention using e-learning; Virtual practice facilitation intervention without e-learning modules
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This trial will investigate the superiority from an effectiveness perspective of: a) a virtual practice facilitation intervention, with a practice facilitator working with practices in virtual one-on-one or group sessions utilizing alcohol use e-learning modules to guide and focus the process and content, compared to b) a virtual practice facilitation intervention, with a practice facilitator working with practices in virtual one-on-one or group sessions without utilizing alcohol use e-learning modules.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Primary Health Care; Alcohol Drinking; Quality Improvement