Implementing Evidence-Based, Electronic, Substance-Use Screening in a Primary Care Clinic

Area of Science:

• Adolescent Medicine
• Public Health
• Digital Health Implementation

Background:

• Substance use often begins in adolescence and can persist into adulthood, necessitating early detection and intervention.
• Adolescent substance use disorders (SUD) pose long-term health risks, emphasizing the need for effective screening protocols.

Purpose of the Study:

• To improve the electronic screening rate for adolescent substance use from 0% to 50% within a quality improvement framework.
• To implement and assess the effectiveness of integrating a SUD screening tool into routine adolescent preventative health visits.

Main Methods:

• A quality improvement project utilized a Plan-Do-Study-Act cycle to enhance SUD screening rates.
• Integrated the Screening to Brief Intervention (SBIRT) tool with the existing Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) tool in the electronic health record (EHR).
• Modified patient eligibility criteria to include adolescents establishing care, addressing a key barrier to screening.

Main Results:

• Achieved a statistically significant increase in electronic SUD screening, with a center-line shift from baseline 0% to 85% (p < .001).
• The screening rate improved from 78% to 83% after broadening eligibility criteria to include new patients.
• Demonstrated successful EHR integration for systematic adolescent SUD screening.

Conclusions:

• EHR integration of SBIRT/CRAFFT tools is an effective strategy for systematic adolescent SUD screening during preventative visits.
• This approach can serve as a model for other institutions seeking to standardize SUD screening for adolescents.
• Proactive screening and early intervention are crucial for addressing adolescent substance use.