It’s not just what you do, it’s how you do it: Variation in substance use screening outcomes with commonly used screening approaches in primary care clinics
Year of Publication
McNeely J; Kannry JL; Rosenthal RN; Wakeman SE; Wilens TE; Farkas S; Adam A; Hamilton L; Rosa C; Wahle A; Pitts S; Rotrosen J
AMERSA 43rd Annual National Conference
NIDA; Variation in substance use screening outcomes with commonly used screening approaches in primary care clinics
Background: Screening for alcohol and drug use is increasingly being adopted in primary care, and clinics often struggle to choose the approach to alcohol and drug screening that is best suited to their resources, workflows, and patient populations. Objective: This multi-site study conducted in the NIDA Clinical Trials Network seeks to inform the implementation and feasibility of electronic health record (EHR)-integrated screening for substance use in primary care. Methods: In two urban academic health systems, researchers worked with stakeholders from 6 clinics to define and implement their optimal screening approach. All clinics used single-item screening questions for alcohol/drugs followed by AUDIT C/DAST-10 for a positive initial screen. Clinics chose between: (1) screening at routine vs. annual visits; and (2) staff-administered vs. computer self-administered screening. Results were recorded in the EHR, and data was extracted quarterly to describe implementation outcomes including screening rate and detected prevalence of unhealthy (moderate-high risk) use among those screened. Screening is ongoing; findings reported here are from the first 3-12 months postimplementation at each clinic. Results: Across sites, of 84,311 patients with primary care visits, 58,492 (69%) were screened. In the 4 clinics with mature (9-12 months) implementation, screening rates ranged from 42-95%. Rates were lower (10-22%) in the 2 clinics that were more recently launched. Screening at routine encounters, in comparison to annual visits, achieved higher screening rates for alcohol (90-95% vs. 42-62%) and drugs (90-94% vs 38-60%). Staff-administered screening, in comparison to patient self-administered screening, had lower rates of detection of unhealthy alcohol use (2% vs. 15-37%). Detection of unhealthy drug use was low at all clinics, ranging from 0.3-1.5%. Conclusions: EHR-integrated screening was feasible to implement in at least 4 of the 6 clinics; 1-year results (available Fall 2019) will determine feasibility at all sites. Self-administered screening at routine primary care visits achieved the highest rates of screening and detection of unhealthy alcohol use. Although limited by differences among clinics and their patient populations, this study provides insight into outcomes that may be expected with commonly used screening strategies in primary care.