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Screening Adolescents for Alcohol Use: Tracking Practice Trends of Massachusetts Pediatricians
Sharon Levy1, Rosemary E Ziemnik, Sion K Harris
1Adolescent Substance Abuse Program, Division of Developmental Medicine, Boston Children's Hospital (SL, REZ, LR, LB), Department of Pediatrics, Harvard Medical School (SL, SKH), Center for Adolescent Substance Abuse Research, Division of Developmental Medicine (SKH), Division of Adolescent/Young Adult Medicine, Boston Children's Hospital (SKH), Division of Child, Youth, and Family Services, Massachusetts Department of Mental Health (CF, HS), Massachusetts Child Psychiatry Access Program, Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA (JHS).
Objectives:
Substance use screening is a recommended component of routine healthcare for adolescents. A 2008 survey of Massachusetts primary care physicians found high rates of screening, but low rates of validated tool use, leading to the concern that physicians may be missing substance use-related problems and disorders. In an effort to improve practice, a cross-disciplinary group developed and distributed an adolescent screening, brief intervention, and referral to treatment toolkit in 2009. A new survey of Massachusetts primary care physicians was conducted in 2014; this report describes its findings, and compares them to those from 2008.
Methods:
A survey was mailed to a randomly selected sample of Massachusetts primary care physicians listed in the state Board of Registration in Medicine database. Item response frequencies were computed. Multiple logistic regression modeling was used to compare 2008 and 2014 responses, while controlling for any demographic differences between samples.
Results:
Pediatrician respondents in 2014 (analysis N = 130) reported a high rate of annually screening patients for alcohol use (96.2%), but only 56.2% reported using a validated screening tool. Rates of screening and validated tool use were higher in 2014 than 2008. Insufficient knowledge as a reported barrier to screening decreased from 2008 to 2014. However, lack of time or staff resources remained key perceived barriers to screening.
Conclusions:
Our findings suggest that adolescent alcohol use screening practices among Massachusetts pediatricians have improved in recent years, during a time of national and statewide efforts to educate physicians. However, opportunities for practice improvement remain.
