Improved Screening and Follow-Up for Unhealthy Alcohol Use in a Federally Qualified Health Center

Background

Alcohol use is a leading cause of morbidity and mortality in the U.S., yet effective screening and intervention remain underutilized in primary care. The U.S. Preventive Services Task Force (USPSTF) recommends screening all adults over 18 for unhealthy alcohol use and providing counseling when screenings are positive. Despite these recommendations, less than 3% of primary care visits include alcohol screenings (Chatterton et al, 2021).

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Residents of Iowa and Nebraska report higher rates of binge drinking (21% vs. the national average of 17%), with Native American and Latinx populations experiencing disproportionately higher alcohol-related complications (Chartier & Caetano, 2010). These groups face barriers to accessing culturally sensitive treatment, including language limitations, discrimination, and economic disadvantages (Le et al., 2024).

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The Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) is a brief, validated screening tool widely recommended for detecting hazardous drinking behaviors (Frank et al., 2008). Responses are scored from 0 to 12, with a score of ≥4 for men and ≥3 for women considered positive for unhealthy alcohol use.

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Methods and Results

Our team applied the Unhealthy Alcohol Use Screening and Follow-Up HEDIS measure to evaluate screening and follow-up rates at OneWorld Community Health Centers in 2023. Among 156 patients who screened positive using AUDIT-C, only 72 (46%) received documented follow-up within 60 days, highlighting a significant gap in care.

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Conclusion

These findings were presented to staff in May 2024, along with recommendations to improve screening documentation and provide access to resources for substance use treatment in concordance with the Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework. Future plans include reassessing follow-up rates and evaluating the impact of these interventions on reducing alcohol-related health burdens within the Omaha community.