Implementing Substance Use Screening and Referral in Primary Care

Abstract

Primary care is the first step to screening and prevention, including the identification of substance use disorder (SUD). The number of patients with SUD has increased significantly in the past 10 years. It is estimated that 65% of patients with SUD are undetected in primary care. Efforts to bring improvement to the Institute for Healthcare Improvement (IHI) triple aim initiatives of improving the health of populations, improving the patient experience and decreasing the per capita cost of patient care are enhanced by community-based screening to identify SUD in primary care. To meet the need for increased screening and prevention of SUD, a scholarly project aimed at implementing Screening, Brief Intervention and Referral to Treatment (SBIRT) was performed at a primary care practice in a rural county of North Carolina. The primary objective of the project was to increase provider adherence to the screening and referral portions of the SBIRT guideline, developed by the Colorado Clinical Guideline Collaborative. SBIRT entails the use of evidence-based screening tools to detect SUD, brief educational interventions to halt or decrease SUD, and Referral to treatment programs. Providers were educated on the evidence supporting SBIRT in primary care, including the use of a single-question screening and the Drug Abuse Screening Tool. The single-question screening helped identify patients who may be at risk for SUD and the DAST-10 was then administered to all who answered in the affirmative. Patients who scored six or greater were referred to further, specialized treatment centers.