Perspectives in Implementing a Primary Care–Based Intervention to Reduce Alcohol Misuse

In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended screening followed by brief behavioral counseling to reduce alcohol misuse. Our study, Options Regarding Consumption of Alcohol (ORCA), was one of the studies included in an evidence review that comprised 23 RCTs. ORCA was designed to test whether a primary care–based intervention would reduce alcohol misuse among patients who screened positive for risky or hazardous drinking. Data collection occurred between 1995 and 1999; data analysis was conducted in 2000–2002. Study design and implementation built from a behavioral counseling research paradigm with four components: (1) population-based screening; (2) centralized delivery of intervention components; (3) involvement of primary care practitioners to motivate and reinforce behavior change; and (4) personalization of intervention components. In this paper, we assess the study features using the Pragmatic–Explanatory Continuum Indicator Summary Model domains. As a randomized trial, the study included some explanatory features (e.g., standardized follow-up surveys administered by study personnel); however, several aspects of the study were highly pragmatic. Practicable recruitment and training of providers, embedding population-based screening in pre-visit surveys, and keeping the delivery of the primary care intervention components consistent with the tempo and competing priorities of practice are three key features that contributed to the study’s success and relevance to the USPSTF.