Original article
A Comparison of Screening Practices for Adolescents in Primary Care After Implementation of Screening, Brief Intervention, and Referral to Treatment

https://doi.org/10.1016/j.jadohealth.2018.12.005Get rights and content

Abstract

Purpose

The American Academy of Pediatrics recommends screening adolescents for substance use at all well-child and appropriate acute-care visits. However, many pediatric practices aim for such screenings annually at well-child visits.

Methods

As part of a larger study, 7 urban Federally Qualified Health Center clinics implemented universal screening for risky alcohol and drug use using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. The present study compared uptake of screening and screening results at well-child versus acute-care visits.

Results

Over a period of 13 months for which encounter-level electronic medical records data were available, there were 6,346 clinic visits by 3,475 unique patients aged 12–17 years, at which 76.6% (n = 4,865) of visits had a screening for problematic substance use conducted. Rates of screening were 95.1% (2,750/2,891 involving 2,629 unique adolescents) for well-child visits and 61.2% (2,115/3,455 involving 1,535 unique adolescents) for acute-care visits. Rates of positive screening results were 9.0% (248/2,750 involving 245 unique adolescents) for well-child visits and 7.8% (164/2,115 involving 126 unique adolescents) for acute-care visits. Of the 469 unique adolescents screened only during an acute-care visit during that same period, 40 unique adolescents had positive screening results for a positive screening rate of 8.5%.

Conclusions

Nearly 10% of adolescent patients screened only at acute-care visits would not have been screened if screening was implemented solely at well-child visits, and 40 adolescents reporting substance use would have been missed. The findings highlight the benefits of screening adolescents at every primary care visit to better detect and intervene in adolescents' substance use.

Section snippets

Patients and Methods

Data for the present study were drawn from a multisite cluster randomized trial of adolescent Screening, Brief Intervention, Referral to Treatment (SBIRT) implementation conducted at seven sites of a large Federally Qualified Health Center (FQHC) in Baltimore, MD (see the study by Mitchell et al., 2016 for methods of parent study) [36]. The randomized trial compared two principal strategies of SBIRT delivery: (1) the generalist strategy, in which the primary care provider delivers a brief

Results

During the 13-month implementation period of the study, there were 6,346 visits by 3,475 unduplicated patients (see Figure 1). Of this total number of visits, adolescents were not screened with the CRAFFT screening tool at 23.4% of visits (n = 1,481).

Of the total number of visits recorded during the implementation period, 95.1% of adolescents completed the screener when seen during an annual well-child visit (2,750 of 2,891 adolescents). However, only 61.2% of adolescents were screened during

Discussion

After the implementation of SBIRT across the seven sites of a large FQHC in Baltimore, MD, participating in an SBIRT implementation trial [36], ATOD screening rates using the CRAFFT substance use items were high throughout the implementation phase, resulting in self-report screening occurring at over 95% of well-child visits. Although the study protocol required clinics to screen universally at every adolescent visit, screenings were completed at less than two-thirds of acute-care visits. This

Acknowledgments

The corresponding author affirms that all persons who contributed significantly to the work in this manuscript have been credited as authors. Findings disseminated in this manuscript were presented at the annual meeting of the Addiction Health Services Research Conference, October 2017.

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    Conflicts of interest: The authors have no conflicts of interest to disclose.

    Clinical Trials number: NCT01829308.

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