Implementation of a Clinical Practice Guideline for High-Risk Drinkers in the Primary Care Setting

Tuesday, 8 July 2008: 10:50 AM
Zena Hyman, DNS, RN , Nursing, Daemen College, Amherst, NY

Learning Objective 1: The learner will be able to discuss the Quality Health Outcomes Model to the integration of clinical practice guidelines in the health care setting.

Learning Objective 2: The learner will be able to consider at least one method for reducing high-risk drinking in the primary care setting.

This presentation presents findings from a pilot study of 45 veterans in which the Quality Health Outcomes Model (QHOM) was used to explore the integration of evidence-based clinical practice guidelines into the clinical setting. As an exemplar, evidence-based practice recommendations for high-risk drinkers in the primary care setting are considered. World-wide public health agencies recommend patient screening in primary health care settings for alcohol “misuse”, and when indicated the provision of brief counseling interventions (Australian DVA, 2002; USPSTF, 2004; WHO, 2003). Brief interventions decrease alcohol consumption among high-risk drinking primary care patients. Yet, even when clinical practice guidelines (CPG) are in place providers are not adequately screening or advising their patients who drink excessively (Seppa et al., 2004). Quantitative and descriptive methods were used to determine the extent to which an existing CPG for primary care patients who are high-risk drinking was implemented. Two different implementation systems (usual care and experimental) were explored and baseline and 3-month alcohol consumption levels were compared. A patient exit questionnaire described the intervention from the patients' perspective and a chart review was conducted to describe the intervention from the providers' perspective. Retrospective chart review found that in 2006, only 46% of the veterans reported any past year drinking. Participants had a mean of 21.3 drinks/week. At least one element of the CPG was implemented 70% part of the time, as reported by the patient. However, on average only 37% of the guideline was implemented. Providers recorded alcohol related discussion/intervention 77% of the time. At follow-up participants had a .03% vs. 39% reduction depending on how the CPG was implemented. The researcher concluded that the QHOM provided a practical and functional approach to both structuring the elements of the study and for explaining and understanding how an intervention such as a CPG is delivered.