Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff
Abstract Background Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical sta...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13722-018-0110-8 |
| _version_ | 1831751017266413568 |
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| author | Jennifer McNeely Pritika C. Kumar Traci Rieckmann Erica Sedlander Sarah Farkas Christine Chollak Joseph L. Kannry Aida Vega Eva A. Waite Lauren A. Peccoralo Richard N. Rosenthal Dennis McCarty John Rotrosen |
| author_facet | Jennifer McNeely Pritika C. Kumar Traci Rieckmann Erica Sedlander Sarah Farkas Christine Chollak Joseph L. Kannry Aida Vega Eva A. Waite Lauren A. Peccoralo Richard N. Rosenthal Dennis McCarty John Rotrosen |
| author_sort | Jennifer McNeely |
| collection | DOAJ |
| description | Abstract Background Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Methods Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13–24, 2006). Results Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient’s substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual’s own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial. Conclusions Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers. |
| first_indexed | 2024-12-21T22:37:32Z |
| format | Article |
| id | doaj.art-1215189117db4906bdb63c995f0665bb |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-12-21T22:37:32Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-1215189117db4906bdb63c995f0665bb2022-12-21T18:47:55ZengBMCAddiction Science & Clinical Practice1940-06402018-04-0113111510.1186/s13722-018-0110-8Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staffJennifer McNeely0Pritika C. Kumar1Traci Rieckmann2Erica Sedlander3Sarah Farkas4Christine Chollak5Joseph L. Kannry6Aida Vega7Eva A. Waite8Lauren A. Peccoralo9Richard N. Rosenthal10Dennis McCarty11John Rotrosen12Department of Population Health, New York University School of MedicineDepartment of Population Health, New York University School of MedicineGreenfield Health and Department of Psychiatry, Oregon Health and Science UniversityDepartment of Population Health, New York University School of MedicineDepartment of Psychiatry, New York University School of MedicineDepartment of Population Health, New York University School of MedicineDivision of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. SinaiDivision of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. SinaiDivision of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. SinaiDivision of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. SinaiDepartment of Psychiatry, Icahn School of Medicine at Mt. SinaiOHSU-PSU School of Public Health, Oregon Health and Science UniversityDepartment of Psychiatry, New York University School of MedicineAbstract Background Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Methods Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13–24, 2006). Results Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient’s substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual’s own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial. Conclusions Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers.http://link.springer.com/article/10.1186/s13722-018-0110-8Substance use disordersDrug abuse screeningAlcohol screeningAlcohol abuseDrug abusePrimary care |
| spellingShingle | Jennifer McNeely Pritika C. Kumar Traci Rieckmann Erica Sedlander Sarah Farkas Christine Chollak Joseph L. Kannry Aida Vega Eva A. Waite Lauren A. Peccoralo Richard N. Rosenthal Dennis McCarty John Rotrosen Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff Addiction Science & Clinical Practice Substance use disorders Drug abuse screening Alcohol screening Alcohol abuse Drug abuse Primary care |
| title | Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff |
| title_full | Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff |
| title_fullStr | Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff |
| title_full_unstemmed | Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff |
| title_short | Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff |
| title_sort | barriers and facilitators affecting the implementation of substance use screening in primary care clinics a qualitative study of patients providers and staff |
| topic | Substance use disorders Drug abuse screening Alcohol screening Alcohol abuse Drug abuse Primary care |
| url | http://link.springer.com/article/10.1186/s13722-018-0110-8 |
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