Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff

Jennifer McNeely, Pritika C. Kumar, Traci Rieckmann, Erica Sedlander, Sarah Farkas, Christine Chollak, Joseph L. Kannry, Aida Vega, Eva A. Waite, Lauren A. Peccoralo, Richard N. Rosenthal, Dennis McCarty, John Rotrosen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: 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, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. METHODS: 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. 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 (Graham et al. in J Contin Educ Health Prof 26(1):13-24, 2006). RESULTS: 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.

Original languageEnglish (US)
Number of pages1
JournalAddiction science & clinical practice
Volume13
Issue number1
DOIs
StatePublished - Apr 9 2018

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Primary Health Care
Urban Health
Workflow
Electronic Health Records
Confidentiality
Focus Groups
Patient Care
Nurses
Alcohols
Interviews
Morbidity
Delivery of Health Care
Physicians
Education
Mortality
Health
Therapeutics
Pharmaceutical Preparations

Keywords

  • Alcohol abuse
  • Alcohol screening
  • Drug abuse
  • Drug abuse screening
  • Primary care
  • Qualitative research
  • Substance use disorders

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Barriers and facilitators affecting the implementation of substance use screening in primary care clinics : a qualitative study of patients, providers, and staff. / McNeely, Jennifer; Kumar, Pritika C.; Rieckmann, Traci; Sedlander, Erica; Farkas, Sarah; Chollak, Christine; Kannry, Joseph L.; Vega, Aida; Waite, Eva A.; Peccoralo, Lauren A.; Rosenthal, Richard N.; McCarty, Dennis; Rotrosen, John.

In: Addiction science & clinical practice, Vol. 13, No. 1, 09.04.2018.

Research output: Contribution to journalArticle

McNeely, J, Kumar, PC, Rieckmann, T, Sedlander, E, Farkas, S, Chollak, C, Kannry, JL, Vega, A, Waite, EA, Peccoralo, LA, Rosenthal, RN, McCarty, D & Rotrosen, J 2018, '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, vol. 13, no. 1. https://doi.org/10.1186/s13722-018-0110-8
McNeely, Jennifer ; Kumar, Pritika C. ; Rieckmann, Traci ; Sedlander, Erica ; Farkas, Sarah ; Chollak, Christine ; Kannry, Joseph L. ; Vega, Aida ; Waite, Eva A. ; Peccoralo, Lauren A. ; Rosenthal, Richard N. ; McCarty, Dennis ; Rotrosen, John. / Barriers and facilitators affecting the implementation of substance use screening in primary care clinics : a qualitative study of patients, providers, and staff. In: Addiction science & clinical practice. 2018 ; Vol. 13, No. 1.
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AU - Vega, Aida

AU - Waite, Eva A.

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