Community Based Outpatient Clinics Summary Report – Evaluation of Alcohol Use Disorder Care at Community Based Outpatient Clinics and Other Outpatient Clinics

The purpose of this systematic review of the Veterans Health Administration’s (VHA’s) Community Based Outpatient Clinics (CBOCs) and other outpatient clinics was to evaluate for compliance with selected VHA requirements regarding alcohol use screening and follow-up in the primary care setting. We conducted this focused review at 56 VA medical centers through the evaluation of the electronic health records of 2,088 patients who had positive scores of 5 and above on the AUDIT-C during July 1, 2013, through June 30, 2014. The objectives were to determine whether outpatient clinics (CBOCs, primary care clinics, and other outpatient clinics) complied with the requirements to provide: (1) further assessment of patients with a positive alcohol screen to determine the level of misuse; (2) education and counseling for patients who identified consumption exceeding National Institute on Alcohol Abuse and Alcoholism guidelines; (3) brief motivational counseling, referral to specialty providers, or other interventions for patients whose excessive alcohol use was persistent; (4) brief treatments for alcohol use disorder through face-to-face, tele-mental health, or phone encounters within 2 weeks of the time that the positive screen is completed; and (5) Patient Aligned Care Team (PACT) clinical staff training in motivational interviewing and National Center for Health Promotion and Disease Prevention health coaching within 12 months of appointment to the PACT. OIG recommended that: (1) clinic staff complete diagnostic assessments for patients with a positive alcohol screen, (2) clinic staff document the offer of further treatment to patients diagnosed with alcohol dependence, (3) clinic staff document a plan to monitor the alcohol use of patients who decline referral to specialty care, (4) clinic Registered Nurse Care Managers receive motivational interviewing training within 12 months of appointment to PACTs, and (5) clinic providers and clinical associates receive health coaching training within 12 months of appointment to PACTs.