Poster presented at the College on Problems of Drug Dependence (CPDD) annual meeting, San Diego, CA, June 9-14, 2018.
Bethany McLeman (Dartmouth, NE Node), Jennifer McNeely, MD, MS (NYU School of Medicine, GNY Node), Elizabeth C. Saunders, MS (Dartmouth, NE Node), Sarah Farkas, MA (NYU School of Medicine, GNY Node), Olivia Walsh (Dartmouth, NE Node), Andrea Meier, MS (Dartmouth, NE Node), Trip Gardner, MD (Dartmouth, NE Node), Noah Nesin, MD (Penobscot Community Health Care, NE Node), Seamus Higgins, Lisa A. Marsch, PhD (Dartmouth, NE Node).
A recently initiated ancillary study of CTN-0062-Ot seeks to integrate screening and clinical interventions for unhealthy alcohol and drug use into rural primary care clinics. Phase 1 aims to define barriers and facilitators to the adoption of substance use screening and clinical decision support in the electronic health record (EHR), and to examine recruitment strategies for rural providers and patients. A total of nine separate focus groups were conducted with primary care providers, medical assistants (MAs), and patients at three federally-qualified health center (FQHC) clinics in Maine. Recruitment followed the approach of the parent study, which is conducted in large urban areas (advance email for providers and MAs, and same-day waiting room recruitment for patients). The interview guide, based on the Knowledge-to-Action framework, addressed key implementation issues including where screening should occur, who should administer the questionnaires, which substances should be identified, and where to embed this information in the EHR.
Sixteen primary care providers, 23 MAs, and four patients participated in separate focus groups. Providers and MAs expressed that substance use screening is valuable to clinical care, and should be integrated into the EHR. To facilitate screening, participants suggested that screening for illicit use be embedded with other services, be universal, assessed at a patient's annual visit, and be delivered in the context of other health questionnaires. Barriers included the sensitivity of substance use information, stigma, and lack of time. Opinions varied regarding self-administered versus staff-delivered screening as the optimal approach.
Conclusions: Participants from rural FQHC clinics identified barriers to substance use screening, but felt it was valuable and feasible if appropriately tailored to clinical workflows. Additional focus groups are needed to capture the attitudes of patients toward screening. Recruitment strategies for patients must account for barriers such as transportation and less experience participating in research. (Poster, PDF, English, 2018)
Keywords: CTN platform/ancillary study | Electronic health records (EHR) | Federally-Qualified Health Centers (FQHCs) | Rural populations | Screening and assessment instruments | Tobacco, Alcohol, Prescription Medication, and Other Substance Use tool (TAPS tool) | College on Problems of Drug Dependence (CPDD) annual meeting, 2018
Document No: 1316.
Submitted by Sarah Farkas, GNY Node, 7/19/2018.