P-053 - Implementing routine substance use disorder screening in a rural family practice

Abstract Title: Implementing routine substance use disorder screening in a rural family practice


Background: Substance use disorder (SUD) is both chronic and costly, with lifelong implications both for patients and the healthcare system as a whole.¹ It is also notably undertreated, with a retrospective cross-sectional study of the 2016-2019 National Survey on Drug Use and Health data reporting that an average of only 13% of patients with a SUD received treatment² In order to more adequately identify and treat patients with SUD, the US Preventive Services Task Force (USPSTF) recommends screening for unhealthy drug use in patients 18 years or older in the primary care setting. In their statement, the National Institute on Drug Abuse (NIDA) Quick Screen was a tool recommended for rapid screening in the primary care setting. This tool evaluates the use of illicit drugs, non-medical use of prescription drugs, tobacco, and alcohol.³ It has also been noted that standardized screening tools are more effective than informal measures.⁴ Additionally, as rural areas are increasingly affected, it is especially important to implement screening.⁵

Purpose/Objectives: To better serve our community by identifying and treating patients with substance use disorders in the rural primary care setting, the NIDA Quick Screen has been implemented as part of a quality improvement project in the Harnett Health Family Medicine Residency Clinic.


Methods: In order to evaluate the baseline for SUD screening in the Harnett Health Family Medicine Residency Clinic, chart review was completed for adult patients who were seen for an annual wellness exam or complete physical exam in a six-month period (September 1, 2023 to March 1, 2024). Residents and staff were educated on the use of the NIDA Quick Screen in lunch and learn sessions, and the tool was implemented in the clinic in May 2024. Screening is administered by nursing staff to adult patients who are being seen for annual wellness exams or complete physical exams during the rooming process. The provider then scores, interprets, and documents the results of the screening and refers as necessary. Following a six-month period, in November 2024, chart review will be completed again to evaluate the success of screening implementation.


Results: Prior to implementation of NIDA Quick Screen in the clinic, chart review was completed on patients eighteen and older seen for a complete physical examination or annual wellness examination between September 1, 2023 and March 1, 2024. Of the 63 patients, only 57% were screened for alcohol use, 70% were screened for tobacco use, 5% for use of prescription drugs for non-medical reasons, and 32% for illegal drug use. In November 2024, after the NIDA Quick Screen has been implemented for a six-month period, chart review will be completed again for post-implementation results.

Conclusions/Implications for future research and/or clinical care: As this abstract is for a work in progress quality improvement project, the conclusions will be better defined after post-implementation results are available in November 2024. At that time, pre-implementation screening will be compared to post-implementation screening to determine if there is a change in screening for substance use disorders in patients when using the NIDA Quick Screen. As the Harnett Health Family Medicine Residency Clinic is now providing SUD treatment, it is vital that accurate screening is implemented. Additional chart review can be performed at that time to evaluate the effect of patients missing their annual examinations on access to screening. Since not all patients undergo annual examinations, possible future projects could investigate how to best reach that population. Other potential future projects may include incorporating screening into the electronic medical record (EMR) to make it more accessible to providers and for use in quality metrics.

References: 1. Pace CA, Uebelacker LA. Addressing unhealthy substance abuse in primary care. Med Clin N Am. 2018;102(4):567-586. doi.org/10.1016/j.mcna.2018.02.004

2. Sahker E, Pro G, Poudyal H, Furukawa TA. Evaluating the substance use disorder treatment gap in the United States, 2016-2019: A population health observational study. Am J Addict. 2024;33(1):36-47. doi:10.1111/ajad.13465

3. US Preventive Services Task Force. Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. JAMA. 2020;323(22):2301-2309. doi:10.1001/jama.2020.8020

4. Jones Q, Johnston B, Biola H, Gomez S, Crowder C. Implementing standardized substance use disorder screening in primary care. JAAPA. 2018;31(10):42-25. doi:10.1097/01.JAA.0000795888.70937.34

5. Moore SK, Saunders EC, Hichborn E, et al. Early implementation of screening for substance use in rural primary care: A rapid analytic qualitative study. Subst Abus. 2021;42(4):678-691. doi:10.1080/08897077.2020.1827125