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

McNeely, Jennifer; Adam, Angéline; Rotrosen, John; Wakeman, Sarah E.; Wilens, Timothy E.; Kannry, Joseph L.; Rosenthal, Richard N.; Wahle, Aimee; Pitts, Seth; Farkas, Sarah; Rosa, Carmen La; Peccoralo, Lauren; Waite, Eva; Vega, Aida; Kent, Jennifer; Craven, Catherine K.; Kaminski, Tamar Arit; Firmin, Elizabeth S.; Isenberg, Benjamin M.; Harris, Melanie; Kushniruk, André; Hamilton, Leah

doi:10.1001/jamanetworkopen.2021.10721

Cited by 41 publications

(39 citation statements)

References 71 publications

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“…Historically, screening for AUD has been inaccurate in primary settings, with a sensitivity of less than 50% based on current practices [78] . Screening is also highly variable across clinic settings [79] , and evidence-based screening tools are under-utilized [80] . Screening tools like the AUDIT-C (Alcohol Use Disorders Identification Test – Consumption), can be short and efficient (i.e.…”

Section: Response To Rising Alcohol Consumption Alcohol Use Disorder ...mentioning

confidence: 99%

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Covid-19 and alcohol associated liver disease

Deutsch‐Link

Curtis²,

Singal³

2022

Digestive and Liver Disease

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Section: Response To Rising Alcohol Consumption Alcohol Use Disorder ...mentioning

confidence: 99%

“…Sensitivity in primary care screening is < 50% and evidence-based tools are underused [78] , [79] , [80]…”

Section: Introductionmentioning

confidence: 99%

Covid-19 and alcohol associated liver disease

Deutsch‐Link

Curtis²,

Singal³

2022

Digestive and Liver Disease

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Section: Introductionmentioning

confidence: 99%

“…Patient self-report can be influenced by a variety of factors, including mode of question administration and sensitivity of content [ 18 , 21 ]. Compared with face-to-face interviews, self-administered, computerized measures can facilitate more accurate reporting of stigmatized behavior [ 19 – 21 ], improve fidelity [ 14 , 22 , 23 ] and increase patient comfort [ 24 ]. On the other hand, stigma, perceived judgment, negative experiences with providers or confidentiality breaches can be barriers to disclosure of anxiety and depression [ 25 – 28 ] as well as substance use [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Patient and provider perspectives on self-administered electronic substance use and mental health screening in HIV primary care

Lea

Altschuler

Leibowitz

et al. 2022

Addict Sci Clin Pract

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Background Substance use disorders, depression and anxiety disproportionately affect people with HIV (PWH) and lead to increased morbidity and mortality. Routine screening can help address these problems but is underutilized. This study sought to describe patient and provider perspectives on the acceptability and usefulness of systematic electronic, self-administered screening for tobacco, alcohol, other substance use, and mental health symptoms among patients in HIV primary care. Methods Screening used validated instruments delivered pre-appointment by both secure messaging and clinic-based tablets, with results integrated into the electronic health record (EHR). Qualitative analysis of semi-structured interviews with 9 HIV primary care providers and 12 patients in the 3 largest HIV primary care clinics in the Kaiser Permanente Northern California health system who participated in a clinical trial evaluating computerized screening and behavioral interventions was conducted. Interviews were audio-recorded and transcribed. A thematic approach was utilized for coding and analysis of interview data using a combination of deductive and inductive methods. Results Four key themes were identified: (1) perceived clinical benefit of systematic, electronic screening and EHR integration for providers and patients; (2) usefulness of having multiple methods of questionnaire completion; (3) importance of the patient–provider relationship to facilitate completion and accurate reporting; and (4) barriers, include privacy and confidentiality concerns about reporting sensitive information, particularly about substance use, and potential burden from repeated screenings. Conclusions Findings suggest that electronic, self-administered substance use and mental health screening is acceptable to patients and may have clinical utility to providers. While offering different methods of screening completion can capture a wider range of patients, a strong patient–provider relationship is a key factor in overcoming barriers and ensuring accurate patient responses. Further investigation into facilitators, barriers, and utility of electronic screening for PWH and other high-priority patient populations is indicated. Trial registration ClinicalTrials.gov, NCT03217058. Registered 13 July 2017, https://clinicaltrials.gov/ct2/show/NCT03217058

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“…17 Not only can this bias results but more visits are likely associated with increases in the likelihood of reporting recent drug use as well. Even when the majority of physicians probe for and record drug use during medical visits, 18,19 a sizable portion of patients may still be unaccounted for. Physicians may also be less likely to ask older patients, in particular, about drug use given a relatively low prevalence of use.…”

mentioning

confidence: 99%