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Barriers and Facilitators Affecting the Implementation of Substance Use Screening in Primary Care Clinics: A Qualitative Study of Patients, Providers, and Staff.

Addiction Science & Clinical Practice 2018;13:8. [doi: 10.1186/s13722-018-0110-8]

Jennifer McNeely, MD, MS (New York University School of Medicine, GNY Node), Pritika C. Kumar, PhD, MPH, MA (New York University School of Medicine, GNY Node), Traci R. Rieckmann, PhD (Oregon Health & Science University, WS Node), Erica Sedlander, MPH (New York University School of Medicine, GNY Node), Sarah Farkas, MA (New York University School of Medicine, GNY Node), Christine Chollak, RN (New York University School of Medicine, GNY Node), Joseph L. Kannry, MD (Icahn School of Medicine, GNY Node), Aida Vega, MD (Icahn School of Medicine, GNY Node), Eva A. Waite, MD (Icahn School of Medicine, GNY Node), Lauren A. Peccoralo, MD (Icahn School of Medicine, GNY Node), Richard N. Rosenthal, MD (Icahn School of Medicine, GNY Node), Dennis McCarty, PhD (Oregon Health & Science University, WS Node), John Rotrosen, MD (New York University School of Medicine, GNY Node).

Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics (the CTN-EHR-PC study, CTN-0062-Ot), researchers interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems affiliated with the NIDA Clinical Trials Network. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices.

Factors affecting implementation based on KTA elements were identified from participant narratives:

  • Identifying the problem: Participants consistently agreed that having knowledge of a patient's substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach.

  • Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual's own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment.

  • Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial.

Conclusions: Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers. (Article (Peer-Reviewed), PDF, English, 2018)

Keywords: Common data elements | Data collection | Electronic health records (EHR) | Primary care | Screening, Brief Intervention, Referral to Treatment (SBIRT) | Addiction Science & Clinical Practice (journal)

Document No: 1309, PMID: 29628018, PMCID: PMC5890352.

Submitted by Sarah Farkas, MA, GNY Node, 4/17/2018.


Chollak, Christine
Farkas, Sarah
Kannry, Joseph L.
Kumar, Pritika C.
McCarty, Dennis
McNeely, Jennifer mail
Peccoralo, Lauren A.
Rieckmann, Traci R.
Rosenthal, Richard N.
Rotrosen, John
Sedlander, Erica
Vega, Aida
Waite, Eva A.
NIDA-CTN-0062-Ot www
Greater New York (Lead) www
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Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
The materials on this site have neither been created nor reviewed by NIDA.
Updated 4/2018 --
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