A Randomized Trial of Alcohol Telemedicine in Primary Care: Pharmacotherapy and Referral Outcomes

Abstract

Importance: Unhealthy alcohol use is commonly identified in primary care, yet most patients do not receive any treatment services. Pharmacists can complement the work of primary care physicians (PCPs), but it is unknown whether they increase patient access to services for alcohol use problems.

Objective: To examine implementation outcomes of a primary care-based, pharmacist-delivered service for patients with unhealthy alcohol use.

Design: A pragmatic, cluster-randomized trial conducted in a large healthcare system between 9/1/2021 and 8/31/2023.

Setting: Primary care clinics block-randomized by facility to an intervention arm (N = 8) or Usual Care (N = 8).

Participants: Primary care providers (204 intervention arm, 132 Usual Care arm) from study clinics.

Intervention: Alcohol Telemedicine Consultation (ATC), involving telephone contact, assessment, motivational enhancement, and specialty referral facilitation.

Main outcomes and measures: Prescriptions for an FDA-approved alcohol use disorder (AUD) medication and referrals to specialty treatment for individuals (age 18 +) who screened positive for unhealthy alcohol use or received an AUD diagnosis between 9/1/2021 and 8/31/2023 summarized by arm.

Results: Bivariate: Collectively, ATC arm providers made 161 referrals to ATC in year 1 and 126 referrals in year 2. Usual Care arm providers made more referrals to specialty treatment (mean (SE) 3.14 (0.28) vs. 2.34 (0.20) in year 1 and 3.24 (0.27) vs.2.43 (0.21) in year 2). Multivariable: Multivariable analyses using zero-inflated Poisson models adjusting for provider characteristics showed that ATC-arm providers prescribed 66% more AUD medications (RR = 1.66, p = 0.001) and made 15% more referrals to specialty treatment (RR = 1.15, p = 0.049) in year 2 compared to Usual Care.

Conclusions and relevance: Referral to ATC may offer an effective approach for improving treatment utilization by increasing pharmacotherapy in primary care, but providers may need training boosters over time.

Trial registration: ClinicalTrials.gov # 1564446.