Rethinking Alcohol Use Disorder Preventive Screening via Virtual Care

New data is showing that preventive screening for alcohol use dropped during COVID-19 surges, despite figures showing that alcohol use increased during the pandemic, prompting some experts to reconsider how virtual care can mediate this problem.

Dips in alcohol use disorder screenings mirror changes in other preventive screenings, like cancer screenings. But unlike cancer screenings, alcohol use disorder screening is adaptable to virtual care. The researchers called on providers to fortify their preventive screening efforts through virtual care, particularly for conditions, like alcohol use, for which screening and counseling are possible via telehealth.

The data, published in Preventive Medicine Reports by researchers at Boston Medical Center, showed a serious drop in alcohol screening during COVID’s initial surge in the spring of 2020 and, to a lesser extent, during other subsequent surges.

This comes as drinking and binge drinking became a bigger problem during the pandemic. According to figures from the Substance Use and Mental Health Services Administration (SAMHSA), more than half of US adults had drunk alcohol within the past month in 2021, with a quarter of adults reporting binge drinking. The data showed that 29.5 million adults had an alcohol use disorder in 2021.

Many of these people may have slipped by their primary care providers, who are usually tasked with screening and counseling for alcohol use disorder, during the onset of the pandemic. Looking at primary care practices in Boston in particular, the researchers calculated rates of screening from July 2019 through May 2022 and overlapped that with COVID-19 case spikes.

At baseline, alcohol use disorder screening rates were around 40 percent, the team reported, but by March 2020, things changed. The stay-at-home advisories and the disruptions those caused to primary and preventive care access resulted in a significant drop in alcohol use disorder treatment screenings, which tanked to a low of 2.1 percent in April and May of 2020.

The researchers credited this drop in screenings to the unprecedented interruption COVID-19 caused to all areas of medicine and everyday life. Although many clinics shifted to telehealth to monitor chronic disease management, preventive care took the backseat as providers and patients alike worked to learn more about the current public health crisis.

Even during preventive encounters that did happen, patients and providers turned their focus to COVID-19 prevention strategies. Moreover, some providers may have lacked a framework for conducting virtual alcohol use disorder screenings, the researchers posited.

After that first surge, screening rates recovered to a rate of 39.8 percent between June 2020 and July 2021, but considerable COVID-19 case surges continue to cause disruptions, although not as drastic as in the spring of 2020.

“Later surges had less impact on screening rates likely due to return of some in-person team-based care, less focus on COVID-related issues during visits and improvements in telemedicine workflows,” the researchers explained.

In the summer and fall of 2021, during the Delta variant wave, alcohol use disorder screenings dropped to 34.2 percent. During December 2021, screening rates were 33.8 percent. And again, when the Omicron variant emerged in January of 2022, screening rates decreased to 27.6 percent.

By study’s end, alcohol use disorder screenings had rebounded back to the pre-pandemic level of 40.4 percent.

Nevertheless, the analysis suggests a need to fortify virtual screening for alcohol use disorder. After all, the verbal or written screening is adaptable to a remote format.

“Due to the importance of prevention through universal, annual alcohol screening, especially given the increases in alcohol related morbidity and mortality during the pandemic, innovative workflow strategies should be considered and prioritized to avoid interruptions of screening for unhealthy alcohol use in primary care,” Dan Alford, MD, MPH, the study’s lead author, a primary care physician at Boston Medical Center, and professor of medicine at Boston University Chobanian & Avedisian School of Medicine, said in a statement.

“We hope that this study highlights the importance of continuing to implement important behavioral health screenings even during challenging periods.”

Particularly, the researchers suggested implementing pre-visit planning and better patient care management during virtual visits. In doing so, primary care providers may pre-empt disruptions to alcohol use disorder screenings during any potential future COVID-19 surges.