A Screening Program for Unhealthy Alcohol Use Integrated Into Electronic Health Record Software Feasible and Effective

This study asks: How are commonly used screening methods for alcohol and drug use associated with implementation outcomes among adult patients in primary care clinics, and what is the best approach for implementing electronic health record–integrated screening?

An electronic health record (EHR)-integrated screening program was able to detect unhealthy alcohol consumption more frequently. These findings, from a quality improvement study, were published in JAMA Network Open.

At 6 primary care clinics in 2 urban academic health care systems located in New York City and Boston, feasibility and success of an EHR-integrated screening program was assessed. The program comprised use of Epic EHR software, specific training sessions for clinicians, medical residents, and medical assistants by research staff, monthly meetings with clinical champions, a 5-minute tailored counseling script accessed through the EHR software, validated screening tools for alcohol and drug use with established cut-offs for risk, and clinical reminders to conduct the assessments.

The 2 clinics in New York City targeted any patients for screening, had a high frequency (1-3 days per week) of screening, and a mixture of staff and self-administration assessments. The 4 clinics in Boston targeted patients for an annual assessment 1 day per week and all assessments were staff-administered.

The experimental clinics assessed between 12,000 and 60,000 patients yearly and the largest clinic had 50 attending physicians and 134 medical residents.

The clinics served a population that was covered by private insurance (81.0%), Medicaid (41.8%), or Medicare (37.0%). Average patient age ranged between 48.9 to 59.1 years, 16.8% to 82.8% of patient populations were White, and 54.8% to 97.7% of patients spoke English.

Among the 93,114 eligible patients, 71.8% were screened for alcohol use and 70.5% for drug use. Moderate to high-risk alcohol use ranged from 1.6% to 36.6% and drug use from 0.3% to 1.0%.

The screening at any visit (New York City clinics) compared with the yearly screenings (Boston clinics) found higher screening rates for alcohol (90.3%-94.7% vs 24.2%-72.0%) and drug (89.6%-93.9% vs 24.6%-69.8%) use, respectively. Staff-administered assessments found more evidence of moderate to high-risk alcohol use (14.7%-36.6%) compared with the clinic which used self-administered exams (1.6%).

The counseling script was not frequently used by clinicians (0.1%-12.5%).

This study was limited by its assessment of counseling. The investigators were unable to determine whether patients received counseling which deviated from the provided counseling script.

These data suggested that the EHR-integrated screening program was implemented successfully and was effective at screening for unhealthy alcohol consumption. The participating clinics have since adopted the EHR-integrated screening program system wide.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


McNeely J, Adam A, Rotrosen J, et al. Comparison of methods for alcohol and drug screening in primary care clinics. JAMA Netw Open. Published online May 20, 2021. doi:10.1001/jamanetworkopen.2021.10721