Screening for Drug Use Effective in Primary Care Settings.
Screening patients in clinical settings can be a first step towards reducing unhealthy alcohol consumption. While there has been some interest in screening for unhealthy drug use, implementation in practice has been slow.
Now, a new study co-authored by a School of Public Health researcher has found that screening for unhealthy drug use can be rapidly implemented in some primary care settings.
The study was published in Substance Abuse.
“We found that drug use in primary care patients, while not common, can easily be screened for as long as the test is brief, though we also found that those who are most likely to be using drugs are not being tested,” says senior author Richard Saitz, professor of community health sciences. “We need to make it easier for clinicians to check for drug use just like they always check for allergies and ask about medications, including over-the-counter and complementary therapies.”
In March 2013, the VHA Medical Center in Bedford, Massachusetts, began piloting screening for drug use, requiring that clinicians in its primary care and outpatient mental health services complete an annual brief screening of all patients. The VHA has used a similar method to identify unhealthy alcohol use since 2004.
“The National Institute on Drug Abuse and other federal and state agencies have developed and disseminated guidance on screening and brief intervention for drug use in general medical settings, and there has been growing research interest in how best to implement it,” the authors wrote. “Until recently, screening for drug use was not required as part of any VHA health system initiative.”
The researchers analyzed the VHA electronic records at the Bedford center for 16,118 patients eligible for the screening program. They assessed first-year rates and predictors of screening and of positive screens for both drug use and unhealthy alcohol consumption. They found that, during the first year of implementation, 70 percent and 84 percent of patients were screened for unhealthy drug use and unhealthy alcohol consumption, respectively. Among those screened for drug use, a prior diagnosis of a drug use disorder was the strongest predictor of a positive screen.
Overall, the screening level was not universal, which had been the goal. However, the authors argued that the results show that, in a clinical setting that has an electronic record and is prepared to improve care quality, very brief services such as a single-question screening test can be rapidly implemented.
“Screening in and of itself is not likely to change drug use, but it is useful to know if a patient is using drugs for safer prescribing, diagnosis, and treatment of just about any symptom and of illnesses,” says Saitz. “Further, it can help start a conversation that may lead to changes in drug use over time, and it lets the patient know that the doctor is interested in helping or considers it a health issue, so that the patient can reach out later if they wish.”
Other authors included Dominic Hodgkin, Elizabeth L. Merrick, Mary Jo Larson, and Constance M. Horgan of Brandeis University; Wenwu Gao, Charles E. Drebing, and Monica Sharma of the Bedford Department of Veterans’ Affairs; and Nancy M. Petry of the University of Connecticut.