Tailored Support Strategy Boosts Alcohol Screening in Primary Care

Study finds practice facilitation increased alcohol use screening and counseling in small and medium-sized clinics.

Jan. 27, 2026 at 11:39am

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A quality improvement study found that a tailored practice facilitation strategy, including coaching, EHR support, and training, led to significant increases in alcohol use screening and counseling among adults at 21 small and medium-sized primary care practices in North Carolina. Screening rates jumped from 17.4% to 57.6%, and the share of patients who screened positive and received brief counseling increased from 0% to 32.3%.

Why it matters

Unhealthy alcohol use is a leading cause of preventable deaths in the U.S., yet less than a third of primary care patients ever discuss alcohol use with their doctor. This study shows that a comprehensive practice facilitation approach can help overcome barriers and integrate evidence-based alcohol screening and counseling into routine primary care workflows.

The details

The study included 21 practices serving over 54,000 adults in North Carolina. The practice facilitation approach involved quality improvement coaching, EHR support, and training on screening and counseling. By the end of the second quarter, mean screening rates increased from 17.4% to 57.6%, and the share of patients who screened positive and received brief counseling rose from 0% to 32.3%.

  • The study period ran from February 2020 to September 2023.
  • The practice facilitation intervention lasted 12 months.

The players

Daniel E. Jonas

MD, MPH, of the Ohio State University College of Medicine in Columbus, and co-author of the study.

Alison N. Huffstetler

MD, and Alex H. Krist, MD, MPH, of Virginia Commonwealth University in Richmond, authors of an accompanying editorial.

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What they’re saying

“Historically, implementation efforts to increase the adoption of evidence-based screening and brief counseling for unhealthy alcohol use in primary care have relied on one-time training sessions, stand-alone educational programs, or EHR [electronic health record] prompts. However, these approaches often failed to create lasting change due to insufficient support, lack of follow-through, and competing clinical demands.”

— Daniel E. Jonas, MD, MPH (JAMA Network Open)

“While ideally, all people with unhealthy use would receive counseling, this improvement is clinically meaningful and shows that primary care can effectively deliver this preventive service.”

— Alison N. Huffstetler, MD (JAMA Network Open)

What’s next

Future practice facilitation efforts could leverage motivational interviewing, especially "micro-motivational interviewing," a 30- to 60-second dialogue "during which the clinician elicits a small amount of change talk from the patient," as a "high-yield option to improve counseling and decrease alcohol use."

The takeaway

This study demonstrates that a comprehensive, tailored practice facilitation approach can help primary care clinics overcome barriers and successfully integrate evidence-based alcohol screening and counseling into routine care, addressing a critical public health issue.