Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural–Urban Variations

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

“…14,43,46,56,57 Studies have also demonstrated that patients living in rural areas receive less follow-up care after positive alcohol screening than patients living in urban areas. 58 Additionally, a recent qualitative study found that while referral to specialty treatment is part of standard practice for patients with AUD among urban providers at the VA, rural providers viewed resources for AUD treatment to be unavailable and inadequate. 56 It may be that PLWH in small rural areas receive less specialty addictions treatment because of these unique barriers to specialty care in rural areas.…”

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

“…Though this study was small and qualitative, perceptions and experiences reported by providers are supported by larger studies that have documented geographic differences in access to and utilization of specialty care, including care for substance use disorders. 28,33,35,[51][52][53] Research has shown that patients who receive primary care services in rural clinics have fewer specialty care encounters in general and significantly lower odds of specialty, mental health, and ancillary visits compared to patients seen in primary care clinics in urban areas. 28,33,53 Studies have also described multiple barriers to accessing substance use treatment in rural settings, including limited availability of treatment services, insufficient funding, transportation barriers, stigma-related barriers, and a lack of interagency collaboration.…”

“…28,33,35,[51][52][53] Research has shown that patients who receive primary care services in rural clinics have fewer specialty care encounters in general and significantly lower odds of specialty, mental health, and ancillary visits compared to patients seen in primary care clinics in urban areas. 28,33,53 Studies have also described multiple barriers to accessing substance use treatment in rural settings, including limited availability of treatment services, insufficient funding, transportation barriers, stigma-related barriers, and a lack of interagency collaboration. 54,55 Because specialty addictions treatment is the goldstandard approach for treating AUD, findings from this and other studies suggest that further work may be needed to increase availability and accessibility of these services in rural areas.…”

“…[24][25][26][27][28][29][30][31] Availability and access to mental health and addiction services may be particularly limited in rural areas; rural areas have fewer behavioral health and treatment resources despite higher prevalence of need as compared to urban areas. [32][33][34][35][36] For providers working in rural clinical settings, communication and collaboration between primary care and specialty care may be particularly challenging due to limited opportunity for informal or "curbside" consultations and inefficient referral strategies with specialty care providers who are often located in geographically distant urban medical centers. [28][29][30][31] Conceptual models of health care access and use, 37 as well as models of dissemination and implementation, 38,39 posit that provider characteristics, including perceptions, experiences, and beliefs and/or actual abilities to execute recommended courses of actions, are likely to influence the extent to which they offer evidence-based care.…”

Attitudes of nursing students towards substance users and perceptions about religious/spiritual care

“…Although the condition of dependency is evident in some cases, it is worth emphasizing that most people who seek health services may be users of some licit or illicit substance, with different consumption patterns, but this consumption may often be undervalued and even neglected or not investigated, including in the case of those users who present some mental health problem associated to drug use, who are prone to be frequent users of emergency units (21) .…”