A Virtual Learning Collaborative for PPRNet Clinicians and Staff: ALC-TRIP (reprise)

1. A Virtual Learning Collaborative for PPRNet Clinicians and Staff: ALC-TRIP (reprise) Lynne Nemeth, PhD, RN, FAAN

2. Objectives • Define the concepts of a virtual learning collaborative and community of practice • Review previous PPRNet experience with Alcohol-TRIP projects • Discuss current NIAAA proposal /opportunity • Develop a relevant set of recommendations to embed in proposal based upon YOUR input

3. Virtual Learning Concepts

4. Virtual Learning Collaborative • Meets the needs of its members through facilitation of peer-to-peer learning • Use social networking and computer-mediated communication to achieve a shared learning objective • Members share knowledge through text discussions, audio, video, blogs, etc. and propose goals and learning objectives

5. Community of Practice (COP) “Groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise by interacting on an ongoing basis”(Wenger, 2002) • COP differs from work groups or teams • Voluntary membership • Goals are less specific/more adaptable • Community exists as long as members participate

6. PPRNet experience

7. Translating Research into Practice-TRIP • Deep PPRNet experience • Operationalized through site visits, network meetings and performance reports • PPRNet must continue to evolve to meet ongoing advances in evidence, and practice development to sustain excellence

8. Alcohol Screening & Brief Intervention (SBI) • USPSTF (2013) recommends that clinicians screen adults aged 18 and older for alcohol misuse and provide persons engaged in risky or hazardous behavior with behavioral counseling to reduce misuse. (B) • Primary care is ideal for the early detection and secondary prevention of alcohol-related problems, due to its high contact-exposure to the population

9. Treatment for Alcohol Use Disorders (AUD) • 14.6% of people with AUD receive treatment (NIAAA, 2011) • Engaging people in primary care where treatment and coordination of other medical conditions occurs is an opportunity to improve • Medications approved by FDA include: • Disulfaram • Oral naltrexone • Extended release naltrexone • Acamprosate

10. How Practices Implemented Alcohol SBI and Treatment in AM-TRIP • Use note templates • Nursing staff screening first 2 questions • Clinician f/u BI with identified HRD patients • Prescribe medications for patients receptive to brief intervention • Use “Rethinking Drinking” materials to educate patients (website, handouts) (Ornstein et al, 2013)

11. Qualitative Conclusions of AM-TRIP • Practices self-organized to adopt specific approaches to incorporating alcohol screening, intervention and medical management into practice • Screening was readily adopted by nursing staff with a consistent, practice-based approach • Clinicians embraced a willingness to address alcohol use in the context of primary care, gaining experience with some medication use • Most patients were receptive to SBI discussion Ornstein et al, 2013; Wessell et al, 2014

12. Current proposal

13. Dissemination and Implementation is Needed • Proposal: virtual learning collaborative (VLC) in PPRNet submitted to NIAAA in Sept • Open to all practices (even if you have participated in a previous study) • Random assignment to VLC or control • All practice clinical staff /providers eligible • CME and nursing CE would be provided for participation

14. Aims • Develop and implement ALC-TRIP, a multi-component virtual learning community for primary care staff and providers. • Compare the effectiveness of participation in ALC-TRIP on alcohol screening, brief intervention and use of alcohol medications to practices that have not participated in this learning community, in a nationwide sample of 15 practices in each group. • Conduct a process evaluation of this learning community to examine the strengths, weaknesses, opportunities and threats related to this approach from the perspective of the stakeholders.

15. recommendations

16. Input • This R25 requires the input of stakeholders in planning this intervention and an Advisory Board to guide the process and evaluation • Need: Letters of support • Need: Practices in AA-TRIP and AM-TRIP studies as advisors--clinicians and staff • Need: your wisdom and experience in expanding practice team roles

17. Site Visits vs. Online Community • What are the qualities of site visits and network meetings that are important to replicate in an on-line community? • Initial site visits seemed like a huge request and time burden for some practices—what concerns arise for this request for participation?

18. Dose • Monthly webinars? • Checking discussions weekly and contributing your ideas, experiences? • 12-18 months for program duration?

19. Your Input is Appreciated Any questions? Letters of support to nemethl@musc.edu