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Drug Alcohol Depend. 2019 Aug 1;201:134-141. doi: 10.1016/j.drugalcdep.2019.04.015. Epub 2019 Jun 8.

Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: An evaluation in three pilot sites.

Author information

1
Kaiser Permanente Washington Health Research Institute, Seattle USA; Department of Health Services, University of Washington, Seattle USA. Electronic address: Julie.E.Richards@kp.org.
2
Kaiser Permanente Washington Health Research Institute, Seattle USA.
3
Kaiser Permanente Washington Health Research Institute, Seattle USA; Department of Health Services, University of Washington, Seattle USA.
4
Kaiser Permanente Washington Health Research Institute, Seattle USA; Department of Health Services, University of Washington, Seattle USA; VA Puget Sound, Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA.
5
Kaiser Permanente Washington Health Research Institute, Seattle USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle USA.
6
Kaiser Permanente Washington Health Research Institute, Seattle USA; VA Puget Sound Health Care System, Center of Excellence in Substance Abuse Treatment and Education, Seattle, USA.
7
Kaiser Permanente Washington, Mental Health and Wellness, Seattle USA.
8
Kaiser Permanente Washington Health Research Institute, Seattle USA; Department of Health Services, University of Washington, Seattle USA; VA Puget Sound, Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA; Department of Medicine, University of Washington, Seattle USA.

Abstract

BACKGROUND:

This pilot study evaluated whether use of evidence-based implementation strategies to integrate care for cannabis and other drug use into primary care (PC) as part of Behavioral Health Integration (BHI) increased diagnosis and treatment of substance use disorders (SUDs).

METHODS:

Patients who visited the three pilot PC sites were eligible. Implementation strategies included practice coaching, electronic health record decision support, and performance feedback (3/2015-4/2016). BHI introduced annual screening for past-year cannabis and other drug use, a Symptom Checklist for DSM-5 SUDs, and shared decision-making about treatment options. Main analyses tested whether the proportions of PC patients diagnosed with, and treated for, new cannabis or other drug use disorders (CUDs and DUDs, respectively), differed significantly pre- and post-implementation.

RESULTS:

Of 39,599 eligible patients, 57% and 59% were screened for cannabis and other drug use, respectively. Among PC patients reporting daily cannabis use (2%) or any drug use (1%), 51% and 37%, respectively, completed an SUD Symptom Checklist. The proportion of PC patients with newly diagnosed CUD increased significantly post-implementation (5 v 17 per 10,000 patients, p < 0.0001), but not other DUDs (10 vs 13 per 10,000, p = 0.24). The proportion treated for newly diagnosed CUDs did not increase post-implementation (1 vs 1 per 10,000, p = 0.80), but did for those treated for newly diagnosed other DUDs (1 vs 3 per 10,000, p = 0.038).

CONCLUSIONS:

A pilot implementation of BHI to increase routine screening and assessment for SUDs was associated with increased new CUD diagnoses and a small increase in treatment of new other DUDs.

KEYWORDS:

Cannabis; Drug use disorders; Primary care; Quality improvement; Screening; Street drugs

PMID:
31212213
PMCID:
PMC6642904
[Available on 2020-08-01]
DOI:
10.1016/j.drugalcdep.2019.04.015

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