Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

Kaiser Permanente9,084 enrolled

Overview

This study evaluates the implementation and effectiveness of two modalities of Screening, Brief Intervention and Referral to Treatment (SBIRT) to reduce adolescent alcohol and other drug (AOD) use in a large pediatrics clinic.

Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize 45 Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care; 2) SBIRT delivered by PCPs; and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiation), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed interventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SCREENING

Masking

NONE

Enrollment

9,084

Conditions

Substance Related Disorders

Interventions

Primary Care PhysicianBEHAVIORAL

The screening, brief intervention and referral to treatment is delivered by the Primary Care Physician

Behavioral Medicine SpecialistBEHAVIORAL

The screening, brief intervention and referral to treatment is delivered by the Behavioral Medicine Specialist.

Eligibility

Sex: ALLMin age: 12 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

There are two study populations as described below thus the large age limit range. Inclusion Criteria: * All adolescent primary care providers at the pediatric primary care clinic will be included. * All adolescent patient electronic records, ages 12-18, at the pediatric primary care will be examined. Exclusion Criteria: * Any adolescent primary care providers not practicing at the pediatric primary care clinic research site will be excluded. * Adolescents electronic records who are not part of the research site pediatric clinic will be excluded.

Locations (1)

Stacy A Sterling

Oakland, California, United States

Outcomes

Primary Outcomes

Screening rate

The proportion of patients who are screened with the Teen Well Check Questionnaire AOD use or Mood symptom questions, among all patients with Teen well-child visits.

Time frame: Initial screening rate - at index well-visit

Problem Identification rate

The proportion of patients screened who answer "yes" to AOD use or Mood symptoms in past 12 months and "yes" to at least one non-car CRAFFT question. (Being in a car with someone using AOD may not be related to child's problem, but to having a parent/other adult who has driven while drinking/using).

Time frame: Initital problem identification rate - at index well-visit, following screening

Assessment rate

Proportion of patients screening positive for alcohol or other drug, or mental health risk, who are assessed further using the CRAFFT tool.

Time frame: Within 2 weeks following index well-visit date

Brief Intervention rate

The proportion of patients who receive an intervention within 14 days, among those who are identified with AOD risk (based on CRAFFT score). Documented in EHR by clinicians, using an ICD-9 Administrative V-code for substance use counseling or behavioral counseling.

Time frame: Within 14 days of assessment at index well visit

Referral to specialty treatment rate

The proportion of patients who receive referrals to specialty behavioral health treatment, among those identified through the CRAFFT as needing such treatment. Documented in the EHR.

Time frame: Within 6 months of index well-visit

Secondary Outcomes

Specialty Behavioral Health Treatment Initiation

Defined as the percent referred, who have at least one specialty behavioral health visit among those identified with a behavioral health problem. Documented in the EHR.

Data from ClinicalTrials.gov

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