Screening for and Managing Substance Use and Abuse
Validated tools bring consistency to practice protocol in primary care offices.
In busy primary care practices, it’s not always easy to integrate screenings for substance use and abuse. Likewise, ensuring a clear path to intervention and treatment if a patient screens positive can be challenging. As the number of adult patients with substance use disorder – including those in the Medicare population – increase, regular screenings are important. Recognizing this need, Kevin McNeill, MD, organized a Quality Improvement project around the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. An SBIRT pilot was applied in three local primary care practices* over three months, including Dr. McNeill’s own practice, LVPG Family Medicine in Hamburg.
SBIRT, recommended by the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental health Services Administration (SAMSA), is an evidence-based method of screening and management. It aims to identify patients whose substance use puts them at hazardous or harmful risk levels so that early intervention and treatment may occur. It starts with a questionnaire. In the case of the primary care pilot at the three LVPG practices mentioned above, laminated questionnaires that could be wiped off and reused were given to patients at check in. The questionnaires were reviewed and scored by the staff. If a patient scored positive, he or she would be moved to the intervention part of the process.
“Depending on the score, a patient may be given a brief intervention and we may provide motivational interviewing, which focuses on harm reduction,” says Dr. McNeill. “If a patient scores high, we make a referral to a behavioral health specialist, either the one that is embedded in our office, or another. We work in concert with Pennsylvania’s Recovery and Monitoring Program (RAMP), and medication assisted treatment for those who need specific assistance.”
Pilot results: More patients need to be screened
Because there have been increases in substance abuse in older populations, the pilot utilized the annual Medicare Annual Wellness Visit as a testing platform. The results showed virtually no instances of undiagnosed substance abuse. However, Dr. McNeill believes SBIRT should be applied to the general adult population. “Once we broaden the scope, I’m sure we will see more positive screens,” he says. While the pilot itself did not produce numbers, it served as an important initial step in establishing a clinically validated, consistent workflow around screenings. “This was a breakthrough in terms of training staff, coordinating a workable process, and developing the practice of connecting with the Populytics care management team for follow-up and referrals,” says Dr. McNeill. “Getting SBIRT into the workflow of every primary care office is an important goal. It’s one that can and will truly benefit our patients and their families as we construct a bigger picture of improved population health.”
*1.) LVPG Hamburg Family Medicine: Robert Blauser, MD; Veronica Brohm, DO; Sara D’Ancona, MD; Alejandro Hernandez, MD. 2.) LVPG Trexlertown Family Medicine: Victorino Sandoval, MD. 3.) Lehigh Valley Family Health Center, Allentown: Lynn Wilson, DO.