Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: An evaluation in three pilot sites

Abstract

Background: This pilot study evaluated whether use of evidence-based implementation strategies to integrate care for cannabis and other drug use into primary care (PC) as part of Behavioral Health Integration (BHI) increased diagnosis and treatment of substance use disorders (SUDs).

Methods: Patients who visited the three pilot PC sites were eligible. Implementation strategies included practice coaching, electronic health record decision support, and performance feedback (3/2015-4/2016). BHI introduced annual screening for past-year cannabis and other drug use, a Symptom Checklist for DSM-5 SUDs, and shared decision-making about treatment options. Main analyses tested whether the proportions of PC patients diagnosed with, and treated for, new cannabis or other drug use disorders (CUDs and DUDs, respectively), differed significantly pre- and post-implementation.

Results: Of 39,599 eligible patients, 57% and 59% were screened for cannabis and other drug use, respectively. Among PC patients reporting daily cannabis use (2%) or any drug use (1%), 51% and 37%, respectively, completed an SUD Symptom Checklist. The proportion of PC patients with newly diagnosed CUD increased significantly post-implementation (5 v 17 per 10,000 patients, p < 0.0001), but not other DUDs (10 vs 13 per 10,000, p = 0.24). The proportion treated for newly diagnosed CUDs did not increase post-implementation (1 vs 1 per 10,000, p = 0.80), but did for those treated for newly diagnosed other DUDs (1 vs 3 per 10,000, p = 0.038).

Conclusions: A pilot implementation of BHI to increase routine screening and assessment for SUDs was associated with increased new CUD diagnoses and a small increase in treatment of new other DUDs.

Keywords: Cannabis; Drug use disorders; Primary care; Quality improvement; Screening; Street drugs.

Figure 1:

Behavioral Health Integration Quality Improvement Support and Evaluation Timeline “Pre“ refers to pre-implementation of BHI; “Post” refers to the period after BHI implementation when practice coaches were supporting the clinics. EHR tools and performance monitoring persisted after the Post phase.

Figure 2:

Screening for Cannabis (A) and Other Drug Use (B) Following Behavioral Health Integration Implementation at Three Primary Care Sites Rates of screening over time, calculated as the proportion of all PC visits in each week in which the patients due for annual screening were screened until the end of active implementation. The dotted vertical lines show the “launch date” of each clinic.