Comparison of Methods for Alcohol and Drug Screening in Primary Care Clinics

• DOI: 10.1001/jamanetworkopen.2021.10721
• Publication Date: 2021-05-20T15:03:57Z
• Authors: Jennifer McNeely; Angéline Adam; John Rotrosen; Sarah E. Wakeman; Timothy E. Wilens; Joseph Kannry; Richard N. Rosenthal; Aimee Wahle; Seth Pitts; Sarah Farkas; Carmen Rosa; Lauren Peccoralo; Eva Waite; Aida Vega; Jennifer Kent; Catherine K. Craven; Tamar A. Kaminski; Elizabeth Firmin; Benjamin Isenberg; Melanie Harris; Andre Kushniruk; Leah Hamilton
• Keywords: Brief intervention; Best practice; Academic detailing

<h3>Importance</h3> Guidelines recommend that adult patients receive screening for alcohol and drug use during primary care visits, but the adoption of in routine practice remains low. Clinics frequently struggle to choose a approach is best suited their resources, workflows, patient populations. <h3>Objective</h3> To evaluate how implement electronic health record (EHR)–integrated substance by comparing commonly used methods examining association with implementation outcomes. <h3>Design, Setting, Participants</h3> This article presents outcomes phases 3 4 4-phase quality improvement, feasibility study which researchers worked stakeholders at 6 clinics 2 large urban academic systems define optimal approach. Site A was located New York City comprised clinics, site B Boston, Massachusetts, clinics. initiated between January 2017 October 2018, 93 114 were eligible use. Data analysis collected 2019, performed from July 13, March 23, 2021. <h3>Interventions</h3> integrated validated questions brief counseling script into EHR, supported clinical champions (ie, clinicians who advocate change, motivate others, expertise facilitate an intervention) training clinic staff. varied approaches, including type visit targeted (any vs annual examinations only), mode administration (staff-administered self-administered patient), extent they facilitation EHR usability testing. <h3>Main Outcomes Measures</h3> EHRs extracted quarterly 12 months measure The outcome rate Secondary prevalence unhealthy detected via screening, clinician script. <h3>Results</h3> Patients had mean (SD) age ranging 48.9 (17.3) years B2 59.1 (16.7) B3, predominantly female (52.4% A1 64.6% A2), English speaking. Racial diversity location. Of 93,114 71.8% received use, 70.5% Screening any (implemented A) comparison only B) associated higher rates (90.3%-94.7% 24.2%-72.0%, respectively) (89.6%-93.9% 24.6%-69.8%). 5 detection moderate- high-risk (14.7%-36.6%) compared 1 staff-administered (1.6%). low across all (0.5%-1.0%). more robust testing somewhat greater moderate-high risk or (1.4%-12.5% 0.1%-1.1%). <h3>Conclusions Relevance</h3> In this improvement study, EHR-integrated feasible when visit. as counseling. These findings can be inform decision-making are seeking <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02963948