1. Lynne Nemeth, PhD, RN, FAAN

2.  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

4.  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.  Learning is an effect of communities  Socio-constructivism (Vygotsky)  Interaction between learners and environment  Learning from others and with others  Social, reflective, authentic, scaffolding, progressive and experiential  Learning is a process of enculturation into a community of practice; requires engagement and contribution

6. “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

8.  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

9.  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

10.  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

11.  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)

12.  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

14.  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

15.  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.

16. We are building this intervention considering the 5 domains of Consolidated Framework (CFIR)  Characteristics of the Intervention (core and adapted components)  Outer setting (economic, political, social context)  Inner setting (structure, networks, readiness, culture)  Individuals (choices, mindsets, norms)  Process of implementation Damschroder LJ, et al 2009 Implementation Science

18.  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

19.  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?

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

21. Any questions? Letters of support to nemethl@musc.edu