在农村联邦合格健康中心诊所实施物质使用筛查，发现成年初级保健患者中存在较高的不健康酒精和大麻使用。
Implementation of substance use screening in rural federally-qualified health center clinics identified high rates of unhealthy alcohol and cannabis use among adult primary care patients.
机构信息
Department of Population Health, Section on Tobacco, Alcohol and Drug Use, New York University Grossman School of Medicine, 180 Madison Ave., 17th Floor, New York, NY, 10016, USA.
Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Evergreen Center, Suite 315, Lebanon, NH, 03766, USA.
出版信息
Addict Sci Clin Pract. 2023 Sep 20;18(1):56. doi: 10.1186/s13722-023-00404-y.
BACKGROUND
Screening for substance use in rural primary care clinics faces unique challenges due to limited resources, high patient volumes, and multiple demands on providers. To explore the potential for electronic health record (EHR)-integrated screening in this context, we conducted an implementation feasibility study with a rural federally-qualified health center (FQHC) in Maine. This was an ancillary study to a NIDA Clinical Trials Network study of screening in urban primary care clinics (CTN-0062).
METHODS
Researchers worked with stakeholders from three FQHC clinics to define and implement their optimal screening approach. Clinics used the Tobacco, Alcohol, Prescription Medication, and Other Substance (TAPS) Tool, completed on tablet computers in the waiting room, and results were immediately recorded in the EHR. Adult patients presenting for annual preventive care visits, but not those with other visit types, were eligible for screening. Data were analyzed for the first 12 months following implementation at each clinic to assess screening rates and prevalence of reported unhealthy substance use, and documentation of counseling using an EHR-integrated clinical decision support tool, for patients screening positive for moderate-high risk alcohol or drug use.
RESULTS
Screening was completed by 3749 patients, representing 93.4% of those with screening-eligible annual preventive care visits, and 18.5% of adult patients presenting for any type of primary care visit. Screening was self-administered in 92.9% of cases. The prevalence of moderate-high risk substance use detected on screening was 14.6% for tobacco, 30.4% for alcohol, 10.8% for cannabis, 0.3% for illicit drugs, and 0.6% for non-medical use of prescription drugs. Brief substance use counseling was documented for 17.4% of patients with any moderate-high risk alcohol or drug use.
CONCLUSIONS
Self-administered EHR-integrated screening was feasible to implement, and detected substantial alcohol, cannabis, and tobacco use in rural FQHC clinics. Counseling was documented for a minority of patients with moderate-high risk use, possibly indicating a need for better support of primary care providers in addressing substance use. There is potential to broaden the reach of screening by offering it at routine medical visits rather than restricting to annual preventive care visits, within these and other rural primary care clinics.
背景
由于资源有限、患者量高以及提供者面临的多种需求，农村初级保健诊所的物质使用筛查面临独特的挑战。为了探索在这种情况下电子健康记录 (EHR) 集成筛查的潜力，我们在缅因州的一家农村合格的联邦健康中心 (FQHC) 进行了一项实施可行性研究。这是 NIDA 临床研究网络对城市初级保健诊所进行筛查的研究 (CTN-0062) 的辅助研究。
方法
研究人员与来自三个 FQHC 诊所的利益相关者合作，定义并实施他们的最佳筛查方法。诊所使用在等候室的平板电脑上完成的烟草、酒精、处方药物和其他物质 (TAPS) 工具，结果立即记录在 EHR 中。有资格接受筛查的是进行年度预防保健就诊的成年患者，但不包括其他就诊类型的患者。在每个诊所实施后的头 12 个月内对数据进行分析，以评估筛查率和报告的不健康物质使用的流行率，以及使用 EHR 集成临床决策支持工具为筛查出中度高风险酒精或药物使用的患者提供咨询的记录情况。
结果
共有 3749 名患者完成了筛查，占有筛查资格的年度预防保健就诊患者的 93.4%，占成年患者进行任何类型初级保健就诊的 18.5%。在 92.9%的情况下，筛查是自我管理的。在筛查中发现的中度高风险物质使用的流行率为：烟草 14.6%、酒精 30.4%、大麻 10.8%、非法药物 0.3%、非医疗用途处方药物 0.6%。为有任何中度高风险酒精或药物使用的 17.4%的患者记录了简短的物质使用咨询。
结论
自我管理的 EHR 集成筛查是可行的实施方法，并且在农村 FQHC 诊所中发现了大量的酒精、大麻和烟草使用情况。为中度高风险使用的少数患者记录了咨询情况，这可能表明需要更好地支持初级保健提供者解决物质使用问题。在这些和其他农村初级保健诊所中，通过在常规医疗就诊时提供筛查而不是限制在年度预防保健就诊时提供筛查，有可能扩大筛查的范围。
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