Asynchronous E-Screening Improves Detection of Unhealthy Alcohol Use in Primary Care: JAMA

Asynchronous e-screening also helped preserve appointment time for shared decision-making and clinical management, making it particularly valuable in hybrid care models where preventive services may otherwise be overlooked. The findings suggest that integrating e-screening into routine primary care workflows can help close longstanding gaps in population-based alcohol screening, improve efficiency, and strengthen preventive care delivery. Further multisite studies are needed to assess long-term sustainability, equity, and downstream clinical outcomes.

A pragmatic trial conducted between June 24 and August 1, 2024, involving two large primary care clinics belonging to VHA network followed by data tracking and modeling until July 2026. The research was performed using a cluster design where primary care clinicians (PCCs) were randomized to intervention or traditional control arms 1:1 according to site. Patients of clinicians belonging to the control arm received usual care that involved conducting the standard AUDIT-C questionnaire verbally in a completely manual mode by the clinic staff during a virtual visit. In case of PCCs allocated to the intervention arm, the patient was sent the automated electronic invite 24 to 48 hours before the visit allowing him/her to take part in an asynchronous, self-administered e-screening.

It should be noted that veterans not filling out the electronic form could receive verbal screening in a traditional way during the virtual consultation. The main trial outcome of the research involved calculating the rate of the AUDIT-C completion, the secondary outcome was the rate of positive screens (the AUDIT-C score was equal to 5 or higher), whereas the exploratory endpoint was the provision of the brief counseling therapy after the positive screen.

Key findings:

• For the studied sample, there were calculated the average age of 55.4 ± 16.1 years, as well as the prevalence of male participants that included 729 people or 86.0% of the total sample.
• The implementation of the previsit electronic screening resulted in a massive rise in telemedicine screening completion rate of 30.5 percentage points, reaching 74.4% (95% CI, 68.5%-80.3%) for the e-screening group compared to the rather poor value of 43.9% (95% CI, 26.6%-61.2%) observed in the usual care one (P < 0.001).
• The electronic screening strategy considerably increased the effectiveness of detection of unhealthy alcohol use, as the positive screen rate reached 10.6% (95% CI, 8.0%-13.2%) compared to only 2.7% positive screens (95% CI, 0.7%-4.7%) reported in the usual verbal care group (P < 0.001).
• In the exploratory study, the share of total veterans who have successfully been provided with a critical brief intervention after a positive screen has dramatically increased from 2.3% (10 of 442 patients) to 5.9% (24 out of 406 patients) in the e-screening intervention arm (P = 0.01).

In summary, using asynchronous e-screening led to better outcomes and more screen positives regarding unhealthy alcohol use among patients attending primary care. Most benefits were seen when conducting the test via telemedicine visits. The overall findings suggest that this strategy is likely to help overcome the implementation gap for screening the entire population, increase disclosures, and decrease the burden on health staff, especially those offering hybrid care. Such definitive quality improvement findings serve as an invaluable empirical basis for modern telemedicine, demonstrating that healthcare organizations should adapt to modern technology to avoid missing vulnerable patients.

Reference:

Reddy A, Nelson KM, Geyer J, et al. Asynchronous Electronic Screening for Unhealthy Alcohol Use Among Veterans in Primary Care: A Cluster Randomized Quality Improvement Trial. JAMA Intern Med. Published online June 29, 2026. doi:10.1001/jamainternmed.2026.1517