Early implementation of screening for substance use in rural primary care: A rapid analytic qualitative study

Abstract

Background: Few primary care patients are screened for substance use. As part of a phased feasibility study examining the implementation of electronic health record-integrated screening with the Tobacco, Alcohol, and Prescription Medication Screening (TAPS) Tool and clinical decision support (CDS) in rural primary care clinics, focus groups were conducted to identify early indicators of success and challenges to screening implementation. Method: Focus groups (n = 6) were conducted with medical assistants (MAs: n = 3: 19 participants) and primary care providers (PCPs: n = 3: 13 participants) approximately one month following screening implementation in three Federally Qualified Health Centers in Maine. Rapid analysis and matrix analysis using Proctor’s Taxonomy of Implementation Outcomes were used to explore implementation outcomes. Results: There was consensus that screening is being used, but use of the CDS was lower, in part due to limited positive screens. Fidelity was high among MAs, though discomfort with the CDS surfaced among PCPs, impacting adoption and fidelity. The TAPS Tool’s content, credibility and ease of workflow integration were favorably assessed. Challenges include screening solely at annual visits and self-administered screening for certain patients. Conclusions: Results reveal indicators of implementation success and strategies to address challenges to screening for substance use in primary care.

Keywords:

• Screening
• substance use
• rural
• primary care
• rapid analysis
• implementation outcomes

Acknowledgment

All aspects of the study were decided by the Lead Investigator (Dr. McNeely), in consultation with the other study investigators and the CCTN project scientist, Carmen Rosa. All publications and presentations from CTN studies are reviewed for quality by the CTN Publications Committee. The content is solely the responsibility of the authors and does not necessarily represent the views of NIDA or the National Institutes of Health.

Additional information

Funding

The study is funded through a cooperative agreement with the NIDA Center for the Clinical Trials Network (CCTN), which is the funding agency for the National Drug Abuse Treatment Clinical Trials Network. UG1DA013035 [PIs John Rotrosen and Edward Nunes], and UG1DA040309 [PI Lisa Marsch].