Low-Burden Universal Substance Use Screening in a Primary Care Clinic to Lower Implementation Barriers

Area of Science:

• Public Health
• Addiction Medicine
• Primary Care

Background:

• Universal substance use screening is recommended in primary care but faces implementation challenges.
• Effective strategies are needed to integrate screening, brief intervention, and referral to treatment (SBIRT) into routine clinical practice.

Purpose of the Study:

• To develop and evaluate a low time- and labor-cost strategy for universal SBIRT in an HIV primary care clinic.
• To assess the feasibility and impact of a computer-based screening system linked to brief interventions.

Main Methods:

• Implemented a tablet-based, self-administered screening tool that provided real-time results and provider prompts.
• Utilized a trained professional for brief motivational interviewing (MI) interventions as needed.
• Integrated the screening and intervention process within an academic medical center's HIV primary care clinic.

Main Results:

• Screened over 1868 patients in 12 months.
• Conducted MI interventions for 101 patients identified with higher-risk substance use.
• Increased referrals for in-clinic treatment to 44 patients, up from 9 the previous year.

Conclusions:

• Computer-based, self-administered screening linked to brief interventions is an effective model for SBIRT in primary care.
• This approach minimizes provider burden while facilitating recommended substance use screening and intervention.
• The strategy shows promise for improving patient outcomes in HIV primary care settings.