Unhealthy alcohol use is often neglected in medical settings despite its known adverse effects on morbidity and mortality. A stepped-wedge cluster randomized implementation trial was designed to improve population-based alcohol-related prevention and treatment of alcohol use disorder (AUD) in primary care practices.

The prevention objective was to determine whether the intervention, compared with usual care, increased the proportion of primary care patients who screened positive for unhealthy alcohol use and had documented brief intervention (counseling). The treatment objective was to test whether the intervention increased the proportion of primary care patients who were newly diagnosed with AUD and engaged in AUD treatment. The intervention included three implementation strategies: practice facilitation, electronic health record (EHR) decision support, and performance feedback.

A total of 333,596 patients (mean age, 48 years; 58% women; 70% White) were included in the study-255,789 during the usual care period and 228,258 during the intervention period. The proportion of patients with a brief intervention documented in the EHR was greater during the intervention period than during the usual care period (57 versus 11, respectively, per 10,000 patients). The proportion of patients with AUD treatment engagement, however, didn't differ during the intervention and usual care periods (1.4 versus 1.8, respectively, per 10,000 patients). All secondary intermediate outcomes, including screening, new AUD diagnoses, and AUD treatment initiation, were significantly higher during the intervention period.

Several factors may potentially limit the generalizability of the intervention, including that the study's measures relied on EHR documentation and insurance claims rather than self-reports, which may be more reliable. In addition, only processes of care were measured, not the effect on patient outcomes.