Implementing standardized substance use disorder screening in primary care

Abstract

Objectives: This quality improvement initiative aimed to develop and implement a protocol for an alcohol and substance use disorder screening for primary care. Methods: The Two Item Conjoint Screen was selected and a process was piloted by care teams. Quality improvement tools were used to improve the protocol. Primary care providers (PCPs) were surveyed about their use of the screening protocol in the primary care setting. Data on total number of screenings were collected through the electronic health record. Results: Implementation resulted in more than 30,000 screenings completed in 2016. PCP survey results indicated that PCPs felt screening was helpful in identifying potential substance use problems (100%) and that most providers (76%) felt that overall patient care improved after screening was initiated. Conclusions: Brief alcohol and substance use disorder screenings can be easily implemented and well integrated into primary care settings. PCPs found screenings to be valuable in caring for patients.

Using SBIRT (Screen, Brief Intervention, and Referral Treatment) Training to Reduce the Stigmatization of Substance Use Disorders Among Students and Practitioners

“… 9 This fragmentation is also challenging for providers, as not knowing where to refer patients with a positive screen can inhibit more regular screening. 3 , 8 , 12 , 15 Integrating care for substance use into primary care and emergency medicine is an effective way to increase early intervention. 16 An integrated approach, especially one that incorporates screening and brief intervention, can not only improve health outcomes for patients and lead to decreased substance use but also reduces the cost of care and increases access to treatment.…”

“…Patients with substance use disorder (SUD) have high rates of comorbidity with mental illness 2 , 3 and experience chronic illness at twice the rate of the general population. 3 , 4 They are also at greater risk of infectious and sexually transmitted diseases; involvement with the criminal justice system; employment issues; and unintentional death from accidents, overdose, or suicide. 5 - 7 It is estimated that the total cost of substance use in the form of health care costs, unearned living wages, and criminal behavior exceed $600 billion annually (NIDA, 2018).…”

“…Barriers that prevent access to SUD treatment include the lack of understanding of SUDs and stigma around substance-using individuals by the public as well as medical providers, a lack of coordinated and integrated care, and insufficient training for practitioners on these topics. 3 , 8 , 11 …”

Should targeted temperature management be used in cardiogenic shock patients? Systematic review and meta-analysis

“…In this regard, targeted temperature management (TTM) through therapeutic hypothermia (32°C -34°C for 12 to 24 hours by surface cooling or endovascular cooling) has been investigated in several studies [6][7][8][9]. This level of hypothermia has a potentially neuroprotective effect [10,11].…”

“…This level of hypothermia has a potentially neuroprotective effect [10,11]. It works by reducing the brain's metabolism and thus the oxygen, adenosine triphosphate, and glucose consumption, which are associated with reducing reperfusion injury [6,9]. The large randomised controlled trial brought more evidence of the beneficial use of TTM in patients after cardiac arrest (CA) with no shockable rhythm, leading to a higher percentage of patients with a favourable neurologic outcome at day 90 [12].…”