Table 1 Practice facilitation components

Facilitator

The facilitator will facilitate the PC clinic’s development of the implementation plan and serve as a content expert who will train staff/providers on evidence-based care for unhealthy alcohol use

Clinic Champion

(Aims 2 & 3)

The facilitator will meet and work with a Clinic Champion(s) to recruit and present the study to PC staff/providers

Aim 2: Focus Groups with small sample of PC clinical stakeholders (N = 5–7)

(Acceptability/Feasibility assessment)

Focus Group Meetings: PC staff and providers interested in helping evaluate acceptability and feasibility (Aim 2) of the practice facilitation will participate in 2–3 successive focus groups, which will be scheduled flexibly around their availability and workflow. Meetings will cover: desired changes in clinic workflow, review ideas for content training in evidence-based alcohol-related care and stigma reduction, recruitment of a local implementation team to support dissemination of knowledge and care processes, and support optimization of existing EHR tools to aid in provision and documentation of alcohol-related care. Meetings will take place over a 4-month timespan. Proposed meeting goals/topics are summarized below

Proposed topics to be covered during Aim 2 focus groups

• Introduce facilitation and didactics (basic concepts regarding best practices for unhealthy alcohol use)

Provide a facilitation example and conduct a current state assessment (what is happening regarding care for alcohol use now?)

Set goals (what do we wish were happening?)

• Create an initial workflow plan

Discuss whether piloting a workflow plan is feasible

Review concept of assessing successes and challenges in piloting plan and making adjustments

Present sample educational materials and garner feedback

• Identify a local implementation team

Identify process for audit and feedback using EHR

Assess acceptability and feasibility of the practice facilitation materials via notes, observations, provider self-report, and debriefing interview

Patient-centered Materials: If education is deemed a top barrier, the facilitator will share patient-centered materials, including a handout on “old” and “new” approaches to thinking about alcohol and health as well as a YouTube video, developed by co-author Dr. Williams, presenting this reframe. Materials will be available for PC staff and providers to use with patients and will be designed to help train staff. Materials for assessment of and referral to treatment for specialty SUD care will also be included

Informatics Tools in EHR: Across all meetings, the facilitator will review three main informatics tools PC providers can use when preventing and intervening on unhealthy alcohol use:

1) Electronic Clinical Reminder. Description of BI when patient screens positive (AUDIT-C)

2) Order Set. This tool walks the clinician through several different ways of approaching treatment for unhealthy alcohol use including provision of a prescription for AUD pharmacotherapy

3) Consult Menu. Easily enables a referral to specialty SUD treatment at the VA medical center

Aim 3: Pilot test of the Practice Facilitation Intervention with Full PC Clinic (Active Implementation)

The facilitator will administer the final version of the practice facilitation intervention via 2 initial welcome group meetings followed by weekly or biweekly meetings with PC providers/staff identified as the local implementation team (for approx. 5 months). Meetings will troubleshoot ongoing issues for providers/staff and include performance monitoring and feedback

Performance Monitoring and Feedback via CDW: Real-time data will be fed back to PC providers regarding rates of patients with unhealthy alcohol use identified, rates of brief intervention offered, rates of consults to PC-MHI and SUD treatment, and rates of prescribed AUD pharmacotherapy