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.