Alcohol Screenings Plummeted during First COVID Surge.
Alcohol Screenings Plummeted during First COVID Surge
As the rates of alcohol-related morbidity and mortality continue to rise, new findings indicate that primary care facilities should prioritize strategies to avoid interruptions of screening for unhealthy alcohol use.
Alcohol screening rates plummeted during the first surge of the COVID-19 pandemic, and unhealthy alcohol consumption and alcohol-related illnesses and deaths rose sharply, according to a new study led by the School of Public Health and Boston Medical Center (BMC).
Published during Alcohol Awareness Month this April in the journal Preventive Medicine Reports, the study found that screening rates in primary care fell from about 40 percent prior to the pandemic to 2.1 percent during the first spike in COVID-19 cases in April and May of 2020.
In 2021, more than 50 percent of US adults drank alcohol within the past month, and more than 25 percent said they engaged in binge drinking—consuming more than five drinks in one day—which is an increase over previous years. The new findings indicate that after widespread stay-at-home orders lifted in June 2020, screening rates rose steadily to pre-pandemic levels through June 2021, despite subsequent COVID-19 waves.
But these rates decreased again to 34 percent during the swift spread of the Delta variant in summer/fall 2021, and even further to 27 percent after the arrival of the highly contagious Omicron variant in January 2022, before returning to baseline levels.
The decline in alcohol screening rates occurred during periods of higher-than-normal healthcare visits and this screening was likely overlooked as clinicians and patients prioritized COVID-related services—such as urgent care, testing, and telehealth appointments—over routine, in-person care.
In telehealth appointments, support staff who would typically provide this service may not be present, but the researchers emphasize that alcohol screening can still be administered effectively in a virtual setting. As advocates emphasize the importance of these screenings as a preventive measure against the dangers of alcohol misuse, the researchers say that primary care facilities should prioritize innovative workflow strategies to avoid interruptions of screening for unhealthy alcohol use.
“The effects of the pandemic have taught us that it is essential to enhance workflows for delivering telemedicine to include important prevention screenings, such as alcohol screening and standardized documentation,” says study lead evaluator and co-author Jacey Greece, clinical associate professor of community health sciences. “While the pandemic forced an increased reliance on telemedicine, it is the future of healthcare delivery and routine screenings have an important place in that delivery of care.”
For the study, the researchers examined alcohol screening rates in primary care practices in Boston before and during the pandemic, from July 2019 through May 2022, utilizing electronic medical records from a BMC database. They mapped screening rates by month to the number of reported COVID-19 cases.
It is possible that screening levels eventually returned to normal once in-person visits resumed and healthcare facilities placed less focus on COVID-related priorities.
“We hope that this study highlights the importance of continuing to implement important behavioral screenings even during challenging periods,” says study lead author Dan Alford, primary care physician at BMC and professor of medicine at Boston University Chobanian & Avedisian School of Medicine.
The researchers say that future research should examine whether the frequency of screening was different between telemedicine and in-person visits during the same time period, as well as explore broader patient-, clinician- and system-level causes for the changes they observed.
“While the data tell us what occurred over the past few years, exploring clinic protocols and provider workflows qualitatively provides insight into the facilitators and barriers to conducting universal and continuous screening,” says study evaluation manager and co-author Candice Bangham, senior evaluation and communication manager in the Department of Community Health Sciences. The evaluation arm of the research team is currently investigating these organizational practices with clinicians through other funded work with screenings in alcohol use and autism.
The study was coauthored by Jacqueline German, program director in the Section of General Internal Medicine at BMC, and Amy Harlowe, program coordinator in the Section of General Internal Medicine at BMC.