Original Research
Systems-Level Approach in Primary Care Improves Alcohol Screening, Counseling, and Pregnancy-Intention Records
Background: The United States Preventive Services Task Force recommends screening adults, including pregnant women, for unhealthy alcohol use and providing brief behavioral counseling when risky drinking is identified. This study examined whether implementing the American Academy of Family Physicians’ Office Champions Quality Improvement Model, a framework that empowers local staff to lead care improvement efforts, could improve alcohol screening and brief intervention. Researchers reviewed 2,725 patient records from 17 family medicine practices at baseline (November 2019–February 2020), after implementation (August–November 2021), and at a sustainability follow-up (April–May 2022). Fourteen practices completed the final follow-up.
What They found: Alcohol screening increased from 61% at baseline to 81% at follow-up, and intervention among patients who screened positive increased from 22% to 67%. Documentation of pregnancy intention improved substantially, with fewer records marked as unknown and more patients identified as trying to become pregnant. Practices also increased use of the validated AUDIT-C screening tool. When patients screened positive, clinicians most often provided brief counseling and goal setting.
Implications: The authors conclude that primary care practices can substantially improve alcohol screening and counseling and prevention of alcohol-exposed pregnancies and fetal alcohol spectrum disorders by embedding team-based workflows, staff training, validated screening tools, and EHR supports into routine care.
Julie Wood, MD, MPH, et al
American Academy of Family Physicians, Leawood, Kansas
The Annals of Family Medicine
26-Jan-2026