Oklahoma researcher uses technology to combat alcohol use disorder in primary care

According to the Centers for Disease Control and Prevention, 1 in 7 adults in the United States will experience a substance use disorder during their lifetime. University of Oklahoma College of Medicine faculty member Brandi Fink, Ph.D., is working with primary care clinics and health care systems to identify people with an alcohol use disorder and intervene early before the problem worsens.

Fink, an associate professor in the Department of Psychiatry and Behavioral Sciences, created an assessment for patients to fill out on an iPad while waiting for an appointment with their primary care provider. Called the Personal Alcohol Management System (PALMS), it provides feedback to users based on their alcohol consumption, including details about how to reduce drinking to a low-risk level. It also lets the provider know the results, with a recommendation to follow up if indicated.

In the first phase of a clinical trial, 235 patients overwhelmingly indicated their acceptance of PALMS with a score of 1.43 on a scale of 1 to 7 (one being the best). For usability, they gave PALMS a score of 87 (a score over 80 is excellent). Fink hopes PALMS brings the topic of alcohol to the forefront of patient-provider discussions.

Studies show that primary care physicians feel unqualified to address alcohol problems, or they feel uncomfortable bringing it up when a patient is there for diabetes management, for example. Time is also a barrier – it's difficult to work the topic into a 15-minute office visit – and providers also lack access to tools and training."

Brandi Fink, Ph.D., faculty member, University of Oklahoma College of Medicine

"In addition, the vast majority of people with a substance use disorder who need treatment don't know that they have a problem and need help," she added. "Those are the people who are already visiting primary care clinics. They just haven't been identified yet."

In the next phase of the trial, Fink plans to test the effectiveness of the system for reducing drinking. She also plans to integrate the assessment into a provider's electronic health record so that patients can access it via the patient portal and fill it out in the comfort of their homes. With this approach, patients tend to be more honest about how much they're drinking, Fink said.

"About 20% of primary care patients are drinking at hazardous or harmful levels, which means that primary care providers will have difficulty controlling their diabetes and hypertension. They're also at higher risk for developing a variety of cancers," she said.

In focus groups, primary care providers reported that PALMS improved their care of patients. Health care administrators said they appreciated PALMS because it helps them manage high-risk patients, which is important to health outcomes and to accrediting bodies, Fink said.

Earlier this year, Fink was selected to attend the Massachusetts Institute of Technology Bootcamps Substance Use Disorders Ventures sponsored by the National Institute on Drug Abuse. The boot camp has a similar mission – to develop new ventures for addressing substance use disorders. Fink was paired with a team of professionals from across the world with expertise in areas like data solutions, machine learning, natural language processing, public health and business, and the group worked with expert coaches. Fink was one of 70 selected to attend from a pool of worldwide applicants.

Fink's team focused on a similar project to her own research, but geared toward identifying undiagnosed substance use disorders among patients in health systems rather than patients in primary care clinics. On the final day of the program, they pitched their idea to a panel of judges, including investors, entrepreneurs and instructors, and received guidance on next steps.

"The program has been exhausting, energizing and inspiring," Fink said. "I have made great relationships that I know will be enduring – personally and professionally. I'm energized to search for novel solutions, not only commercially, but in my clinical research and practice, too, in order to improve the health of Oklahomans."