The purpose of this study was to evaluate the impact of simultaneous systems interventions and clinician training on management of hazardous and harmful drinking in a residency clinic. Systems interventions included forming a multi-disciplinary implementation team, training registration clerks to distribute health risk questionnaires using the AUDIT-C alcohol screen, and training nurses to score the AUDIT-C and administer the AUDIT to screen-positive patients. Clinicians were trained to perform brochure-based interventions on screen-positive patients. Research staff provided compliance feedback. Over 12 months, 8.0% (241/3014) of patients screened positive and 3.8% (115/3014) received brief interventions. For screen-positive patients, comparisons with baseline measurements found increased rates of alcohol assessment (50% vs. 0%, p <.0001) and intervention (48.1% vs. 9.4%, p <.0001). Clinicians intervened more often when prompted with completed AUDITs (72% vs. 23%, p <.0001). Program modifications resulted in progressive increases in numbers of patients screened. This model shows promise for use in other residency programs.
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