TY - JOUR
KW - primary care
KW - rural
KW - Screening
KW - Substance use disorder
AU - E. C. Saunders
AU - S. K. Moore
AU - T. Gardner
AU - S. Farkas
AU - L. A. Marsch
AU - B. McLeman
AU - A. Meier
AU - N. Nesin
AU - J. Rotrosen
AU - O. Walsh
AU - J. McNeely
A1 - 
AB - BACKGROUND: Substance use frequently goes undetected in primary care. Though barriers to implementing systematic screening for alcohol and drug use have been examined in urban settings, less is known about screening in rural primary care. OBJECTIVE: To identify current screening practices, barriers, facilitators, and recommendations for the implementation of substance use screening in rural federally qualified health centers (FQHCs). DESIGN: As part of a multi-phase study implementing electronic health record-integrated screening, focus groups (n = 60: all stakeholder groups) and individual interviews (n = 10 primary care providers (PCPs)) were conducted. PARTICIPANTS: Three stakeholder groups (PCPs, medical assistants (MAs), and patients) at three rural FQHCs in Maine. APPROACH: Focus groups and interviews were recorded, transcribed, and content analyzed. Themes surrounding current substance use screening practices, barriers to screening, and recommendations for implementation were identified and organized by the Knowledge to Action (KTA) Framework. KEY RESULTS: Identifying the problem: Stakeholders unanimously agreed that screening is important, and that universal screening is preferred to targeted approaches. Adapting to the local context: PCPs and MAs agreed that screening should be done annually. Views were mixed regarding the delivery of screening; patients preferred self-administered, tablet-based screening, while MAs and PCPs were divided between self-administered and face-to-face approaches. Assessing barriers: For patients, barriers to screening centered around a perceived lack of rapport with providers, which contributed to concerns about trust, judgment, and privacy. For PCPs and MAs, barriers included lack of comfort, training, and preparedness to address screening results and offer treatment. CONCLUSIONS: Though stakeholders agree on the importance of implementing universal screening, concerns about the patient-provider relationship, the consequences of disclosure, and privacy appear heightened by the rural context. Findings highlight that strong relationships with providers are critical for patients, while in-clinic resources and training are needed to increase provider comfort and preparedness to address substance use.
AD - The Dartmouth Institute (TDI) for Health Policy and Clinical Practice, Lebanon, NH, USA. Elizabeth.C.Saunders.gr@dartmouth.edu.; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.; Penobscot Community Health Care (PCHC), Bangor, ME, USA.; Department of Psychiatry, New York University School of Medicine, New York, NY, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.; Penobscot Community Health Care (PCHC), Bangor, ME, USA.; Department of Psychiatry, New York University School of Medicine, New York, NY, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.; Department of Population Health, New York University School of Medicine, New York, NY, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 12
CY - United States
DO - 10.1007/s11606-019-05232-y
IS - 12
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Substance use frequently goes undetected in primary care. Though barriers to implementing systematic screening for alcohol and drug use have been examined in urban settings, less is known about screening in rural primary care. OBJECTIVE: To identify current screening practices, barriers, facilitators, and recommendations for the implementation of substance use screening in rural federally qualified health centers (FQHCs). DESIGN: As part of a multi-phase study implementing electronic health record-integrated screening, focus groups (n = 60: all stakeholder groups) and individual interviews (n = 10 primary care providers (PCPs)) were conducted. PARTICIPANTS: Three stakeholder groups (PCPs, medical assistants (MAs), and patients) at three rural FQHCs in Maine. APPROACH: Focus groups and interviews were recorded, transcribed, and content analyzed. Themes surrounding current substance use screening practices, barriers to screening, and recommendations for implementation were identified and organized by the Knowledge to Action (KTA) Framework. KEY RESULTS: Identifying the problem: Stakeholders unanimously agreed that screening is important, and that universal screening is preferred to targeted approaches. Adapting to the local context: PCPs and MAs agreed that screening should be done annually. Views were mixed regarding the delivery of screening; patients preferred self-administered, tablet-based screening, while MAs and PCPs were divided between self-administered and face-to-face approaches. Assessing barriers: For patients, barriers to screening centered around a perceived lack of rapport with providers, which contributed to concerns about trust, judgment, and privacy. For PCPs and MAs, barriers included lack of comfort, training, and preparedness to address screening results and offer treatment. CONCLUSIONS: Though stakeholders agree on the importance of implementing universal screening, concerns about the patient-provider relationship, the consequences of disclosure, and privacy appear heightened by the rural context. Findings highlight that strong relationships with providers are critical for patients, while in-clinic resources and training are needed to increase provider comfort and preparedness to address substance use.
PP - United States
PY - 2019
SN - 1525-1497; 0884-8734
SP - 2824
EP - 2832
EP - 
T1 - Screening for Substance Use in Rural Primary Care: a Qualitative Study of Providers and Patients
T2 - Journal of general internal medicine
TI - Screening for Substance Use in Rural Primary Care: a Qualitative Study of Providers and Patients
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 31414355
U3 - 10.1007/s11606-019-05232-y
VL - 34
VO - 1525-1497; 0884-8734
Y1 - 2019
Y2 - Dec
ER -