Unhealthy Drinking Behavior and the ATTAIN Solution: Web-based Automated Alcohol Misuse Interventions.

backgroundUp to 30% of American adults may have unhealthy drinking behavior, but only 17% get screened. There is promise in improving screening via technology, but there is a lack of published evidence supporting these efforts. We describe the development of Automated Alcohol Misuse Interventions (ATTAIN), an automated, web-based process to screen for and manage adults with unhealthy drinking behavior with minimal involvement of health-care personnel.

methodAfter creating a strategic business plan, ATTAIN was developed for the Southern California Permanente Medical Group using its integrated model of care, electronic medical records, and patient portal. ATTAIN is based on an automated branching questionnaire that screens for unhealthy drinking behavior and, when applicable, alcohol use disorders, and incorporates questions about readiness to change and interest in medications/counseling to assist with alcohol consumption reduction. Health plan members would be invited via email to fill out the screening questionnaire using the patient portal. Based on their responses, they would receive appropriate automated feedback and a link to a counseling video about the spectrum of alcohol use. Patients' responses would be captured in their medical record and sent to a designated provider for further help as needed. The process would be refined through successive quality improvement pilots. We project that ATTAIN will lead to reduced costs for the Southern California Permanente Medical Group .

conclusionThis effort has paved the way for using ATTAIN to improve patient care and to reduce the costs associated with managing unhealthy drinking, and potentially leads to similar processes for other medical conditions and health-related behaviors.