Costs of using evidence‐based implementation strategies for behavioral health integration in a large primary care system

“…Kaiser Permanente Washington screens primary care patients annually for cannabis use as part of integrated mental health care. 7 , 8 Data (obtained exclusively from KPWA’s Epic EHR and insurance claims) included patient demographic characteristics, diagnoses, cannabis screen results, medication fills, and EHR free-text documentation (eg, encounter notes). This study received approval and waivers of consent and Health Insurance Portability and Accountability Act authorization from the KPWA Health Research Institute Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Medical Cannabis Use and Associated Health Conditions Documented in Electronic Health Records Among Primary Care Patients in Washington State

et al. 2021

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Key Points Question Among primary care patients, what is the prevalence of electronic health record documentation of medical cannabis use and health conditions for which cannabis use might have benefits and risks? Findings In this cross-sectional study of 185 565 patients, 2% had past-year medical cannabis use documented in their electronic health records. Among patients with documented medical cannabis use, 44.5% had documented health conditions for which cannabis use might confer benefits, and 54.5% had conditions for which it might confer risks. Meaning These findings suggest that primary care practitioners should be prepared to discuss potential risks as well as potential benefits of cannabis use with patients.

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“…19 Prioritizing a sensitive threshold may be appropriate as part of behavioral health screening in primary care settings when the screen is followed by low-cost, low-burden, nonstigmatizing symptom assessment and discussion of symptoms. 27,41 Prioritizing a specific threshold that minimizes false positive screens might be more appropriate in resource-constrained settings or those in which a positive screen results in referral. 57 The SIS-C is not a replacement for assessment of CUD symptoms or for making a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…The term marijuana was not defined and could include medical and nonmedical use—relevant in cannabis-legal settings where medical authorization by a clinician is not required. The SIS-C was embedded in the 7-item behavioral health questionnaire, 27 , 41 self-administered on paper during the study period. An electronic flag prompted administration of the screen after check-in if patients had not been screened in the past year, and a medical assistant entered responses into the EHR before the physician visit.…”

Section: Methodsmentioning

confidence: 99%

Validity of the Single-Item Screen–Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care

et al. 2022

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ImportanceCannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition.ObjectiveTo evaluate the Single-Item Screen–Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD.Design, Setting, and ParticipantsThis diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022.ExposuresThe SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients’ medical records.Main Outcomes and MeasuresThe Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview–Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population.ResultsOf 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%.Conclusions and RelevanceIn this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.

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Costs of using evidence‐based implementation strategies for behavioral health integration in a large primary care system

Cited by 19 publications

References 30 publications

Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients

Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients

Prevalence of Medical Cannabis Use and Associated Health Conditions Documented in Electronic Health Records Among Primary Care Patients in Washington State

Validity of the Single-Item Screen–Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care

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