Successful Implementation of Substance Use Screening in Rural Federally-Qualified Health Centers Identified High Rates of Unhealthy Alcohol, Cannabis, and Tobacco Use
Year of Publication
McNeely, Jennifer; McLeman, Bethany; Gardner, Trip; Nesin, Noah; Farkas, Sarah; Wahle, Aimee; Pitts, Seth; Kline, Margaret; King, Jacquie; Rosa, Carmen; Marsch, Lisa; Rotrosen, John; Hamilton Leah
The College on Problems of Drug Dependence (CPDD)
Aim Screening for substance use in rural primary care clinics faces unique challenges due to limited resources, high patient volumes, and multiple demands on providers. To explore the potential for electronic health record (EHR)-integrated screening, we conducted an implementation feasibility study with a rural federally-qualified health center (FQHC) in Maine. This was an ancillary study to a NIDA Clinical Trials Network study of screening in urban clinics (CTN-0062). Methods Researchers worked with stakeholders from 3 FQHC clinics to define and implement their optimal screening approach. Clinics used the TAPS Tool, completed on tablets in the waiting room, and results were immediately recorded in the EHR. Adults presenting for annual preventive care visits were eligible for screening. Data were collected between 11/1/2018-5/5/2020, and analyzed for the first 12 months following implementation at each clinic to assess screening rates and prevalence of reported unhealthy substance use. Results Screening was completed by 3,749 patients, representing 93.4% of those eligible and 18.4% of all adult patients presenting for primary care visits. In 92.9% of cases, screening was self-administered. Current unhealthy substance use (TAPS score 1+ for at least one substance) was identified in 1,219 patients (32.5% of those screened): 508 (13.6%) had unhealthy use of tobacco, 1064 (28.4%) alcohol, 383 (10.2%) cannabis, 11 (0.3%) illicit drugs, and 18 (0.5%) non-medical use of prescription drugs. Conclusion Self-administered EHR-integrated screening was feasible to implement and detected substantial alcohol, cannabis, and tobacco use in rural FQHC clinics. Rates of drug use (including cannabis) identified through screening were higher (10% vs. 0.3-1.0%) than in the parent study, possibly because the TAPS allows patients to report cannabis separately from other drugs in a cannabis-legal state. Future work may broaden the reach of screening by offering it at routine visits rather than restricting to annual preventive care, within these and other rural clinics.