Did Universal Alcohol Screening and Brief Interventions Delivered in the Context of Reproductive Health Care Universally Reach Demographically Diverse Patients?

Abstract

Objective

To identify demographic disparities in rates of alcohol screening and brief intervention (ASBI) aimed at reducing the risk of alcohol-exposed pregnancy (AEP).

Design

Electronic health record data were analyzed to examine documented ASBI rates and contraceptive methods for patients who had wellness visits between June 1, 2020, and October 31, 2022.

Setting/Local Problem

This study included 15 health centers affiliated with Planned Parenthood of Southern New England (PPSNE) and 35 health centers affiliated with Planned Parenthood of the Great Northwest, Hawaii, Alaska, Indiana, Kentucky (PPGNHAIK). Affiliates collaborated on a 4-year project implementing universal ASBI to reduce risky alcohol use and prevent AEPs.

Participants

Data included 29,659 patients assigned female at birth, ages 18 to 49 years, who completed a wellness visit at a participating health center.

Intervention/Measurements

Electronic health record data encompassed demographic characteristics, contraception method, patient-completed alcohol screening score, and clinician-documented brief interventions.

Results

Although alcohol screening rates exceeded 85% of eligible visits, brief intervention completion rates for those at risk for AEP were low: 70.5% were missed at PPSNE and 78.2% were missed at PPGNHAIK. At PPSNE, Hispanic patients at risk for AEP were least likely to receive a brief intervention (75.9% missed) compared to Black (67.7%) or white (67.5%) patients (p < .001). At PPGNHAIK, Asian/Pacific Islander patients were most likely to miss receiving a brief intervention (92.2%) compared to Black (72.9%), race unknown (79.5%), white (77.9%), and multiracial/other (78.4%) patients (p < .003).

Conclusion

Universal ASBI is recommended to normalize asking about alcohol in reproductive health care, reduce subjectivity, and ensure that all patients benefit from alcohol education or intervention. Variation in screening rates and contraception type contribute to demographic differences in risk of AEP.

Clinical Implications

• Universal alcohol screening and brief intervention methods can be implemented by nurses in the context of contraception counseling in reproductive health care settings to identify and address excessive alcohol use across racially and ethnically diverse patient populations.
• Inequities in access to health care and information about the risks of alcohol-exposed pregnancy (AEP) can be reduced by standardizing conversations about substance use and contraception to prevent AEP.
• Quality of patient care can be enhanced by discussing individuals’ reproductive goals and concerns about contraception and pregnancy to ensure that the recommendations consider each patient’s goals and beliefs.