TOPLINE

In a health system with routine screening for substance use, variations in screening were noted at patient, provider, and clinic levels. Characteristics of patients such as needing an interpreter and having alcohol-related cognitive disorders were associated with a lower probability of screening, whereas anxiety disorders, depression, and cannabis use disorder were linked to higher probability of screening.

METHODOLOGY

• Researchers conducted a retrospective longitudinal cohort study including 479,634 adult patients in primary care who contributed nearly 1.1 million observations between 2019 and 2022 in a US health system.
• Patients were distributed across 802 primary care providers, 36 clinics, and 428 counties.
• The primary outcome was the receipt of screening for substance use (alcohol, cannabis, or other drugs) on the date of the index visit or within the prior year, assessed using validated measures.
• The researchers estimated the probability of completion of guideline-concordant screening and quantified the proportion of variation in outcomes using intraclass correlation coefficients (ICCs).
• Associations between factors at the patient level (demographics and diagnosis of substance use disorders), provider level (visit volume per month and years of experience), clinic level (visit volume per month and mental health staffing), and community level (rurality and rate of unemployment) and the completion of screening were quantified.

TAKEAWAY

• Variation in screening was noted at the patient (ICC, 0.075), provider (ICC, 0.033), and clinic (ICC, 0.016) levels.
• Patients requiring an interpreter had a lower probability of being screened (average marginal effect [AME], -0.041; P < .001), as did those with alcohol-related cognitive disorders (AME, -0.189; P = .001) or nervous system disorders (AME, -0.038; P = .019).
• Anxiety disorders (AME, 0.029; P < .001), depression (AME, 0.039; P < .001), and cannabis use disorder (AME, 0.040; P < .001) were associated with a higher probability of screening.
• Higher provider monthly visit volume was associated with a lower probability of screening (AME, -0.022; P = .021), whereas delivering a greater number of distinct procedure types was associated with a higher probability of screening (AME, 0.048; P = .034).

IN PRACTICE

"The current findings help contextualize calls for multi-level quality improvement efforts to improve the provision of substance use screening in health systems," the researchers wrote. "Health systems may benefit from provider-level interventions to ensure that patients are issued guideline-concordant substance use screening," they added.

SOURCE

The study was led by Joseph E. Glass, PhD, MSW, of the Chestnut Health Systems at the Lighthouse Institute in Eugene, Oregon. It was published online on August 19 in the Journal of General Internal Medicine.

LIMITATIONS

Health conditions were assessed using electronic health record and claims data, potentially missing undocumented conditions. Alcohol, cannabis, or other drug screening could not be distinguished in the study because they were issued on a single instrument. The analyses examining the association between covariates and completion of screening were exploratory.

DISCLOSURES

The research was supported by the National Institute on Alcohol Abuse and Alcoholism. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.