Leveraging technology to address unhealthy drug use in primary care: Effectiveness of the Substance use Screening and Intervention Tool (SUSIT)

Abstract

Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based ‘Substance Use Screening and Intervention Tool (SUSIT)’. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control ‘screening only’ (SO) period to an intervention ‘SUSIT’ period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient’s screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.

Keywords:

• Unhealthy drug use
• substance use disorder
• screening
• brief intervention
• primary care
• HIV

Acknowledgments

The authors acknowledge the collaboration of the clinical leaders who supported and facilitated this research, including Annie Garment, Gregory Lee, and Andrew Wallach. They further acknowledge those who contributed to the development of the SUSIT tool, including Andre Kushniruk, Devin Mann, Michael Cantor, Barbara Porter, and Sarah Moore. They also wish to thank the many primary care providers and patients of the New York City Health + Hospitals system for participating in the study.

Author contributions

JM conceived of the SUSIT intervention; JM, CC and DS contributed to the design of the study; AP, AS, SF collected the data; CC and MM led the data analysis and interpretation of the results. JM took the lead in writing this manuscript. All authors, JM, MM, NA, AB, AP, SF, AS, DS and CC provided critical feedback and contributed to the writing of the manuscript.

Disclosure statement

Dr. McNeely reports intellectual property for the ‘Substance Use Screening and Intervention Tool’ that was developed with funds from the National Institute on Drug Abuse (R34DA040830) and is in the public domain. Dr. McNeely has served as a consultant to the National Committee for Quality Assurance (NCQA). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health or the National Institute on Drug Abuse.

Additional information

Funding

This material is based upon work supported by the National Institute on Drug Abuse (NIDA) grant R34DA040830. NIDA had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.