Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;38(2):332-340.
doi: 10.1007/s11606-022-07675-2. Epub 2022 May 25.

Integrating Routine Screening for Opioid Use Disorder into Primary Care Settings: Experiences from a National Cohort of Clinics

Elizabeth J Austin  1 , Elsa S Briggs  2 , Lori Ferro  3 , Paul Barry  4 , Ashley Heald  4 , Geoffrey M Curran  5   6 , Andrew J Saxon  3   7 , John Fortney  3   4   8 , Anna D Ratzliff  3   4 , Emily C Williams  2   8
Affiliations

Integrating Routine Screening for Opioid Use Disorder into Primary Care Settings: Experiences from a National Cohort of Clinics

Elizabeth J Austin et al. J Gen Intern Med. 2023 Feb.

Abstract

Background: The U.S. Preventive Services Task Force recommends routine population-based screening for drug use, yet screening for opioid use disorder (OUD) in primary care occurs rarely, and little is known about barriers primary care teams face.

Objective: As part of a multisite randomized trial to provide OUD and behavioral health treatment using the Collaborative Care Model, we supported 10 primary care clinics in implementing routine OUD screening and conducted formative evaluation to characterize early implementation experiences.

Design: Qualitative formative evaluation.

Approach: Formative evaluation included taking detailed observation notes at implementation meetings with individual clinics and debriefings with external facilitators. Observation notes were analyzed weekly using a Rapid Assessment Process guided by the Consolidated Framework for Implementation Research, with iterative feedback from the study team. After clinics launched OUD screening, we conducted structured fidelity assessments via group interviews with each site to evaluate clinic experiences with routine OUD screening. Data from observation and structured fidelity assessments were combined into a matrix to compare across clinics and identify cross-cutting barriers and promising implementation strategies.

Key results: While all clinics had the goal of implementing population-based OUD screening, barriers were experienced across intervention, individual, and clinic setting domains, with compounding effects for telehealth visits. Seven themes emerged characterizing barriers, including (1) challenges identifying who to screen, (2) complexity of the screening tool, (3) staff discomfort and/or hesitancies, (4) workflow barriers that decreased screening follow-up, (5) staffing shortages and turnover, (6) discouragement from low screening yield, and (7) stigma. Promising implementation strategies included utilizing a more universal screening approach, health information technology (HIT), audit and feedback, and repeated staff trainings.

Conclusions: Integrating population-based OUD screening in primary care is challenging but may be made feasible via implementation strategies and tailored practice facilitation that standardize workflows via HIT, decrease stigma, and increase staff confidence regarding OUD.

Keywords: opioid use disorder; primary care; screening.

PubMed Disclaimer

Conflict of interest statement

The authors do not have any personal, professional, or financial conflicts of interest to disclose for this work. The authors did not work with or were otherwise influenced by any external sponsors for this work. Dr. Saxon has received travel support from Alkermes, Inc., consulting fees from Indivior, Inc., and royalties from UpToDate, Inc. Anna Ratzliff, MD, PhD receives royalties from Wiley for her book on integrated care.

Figures

Figure 1
Figure 1
Flow of study implementation and evaluation activities.
See this image and copyright information in PMC

References

    1. Donroe JH, Bhatraju EP, Tsui JI, Edelman EJ. Identification and management of opioid use disorder in primary care: an update. Curr Psychiatry Rep. 2020;22(5):23. doi: 10.1007/s11920-020-01149-0. - DOI - PubMed
    1. Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021. Designed by LM Rossen, A Lipphardt, FB Ahmad, JM Keralis, and Y Chong: National Center for Health Statistics. Accessed at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
    1. Bradley KA, Lapham GT, Lee AK. Screening for drug use in primary care: practical implications of the new USPSTF recommendation. JAMA Intern Med. 2020;180(8):1050. doi: 10.1001/jamainternmed.2019.7335. - DOI - PMC - PubMed
    1. Lapham G, Boudreau DM, Johnson EA, Bobb JF, Matthews AG, McCormack J, Liu D, Samet JH, Saxon AJ, Campbell CI, Glass JE, Rossom RC, Murphy MT, Binswanger IA, Yarborough BJH, Bradley KA, PROUD Collaborative Investigators Prevalence and treatment of opioid use disorders among primary care patients in six health systems. Drug Alcohol Depend. 2020;207:107732. doi: 10.1016/j.drugalcdep.2019.107732. - DOI - PMC - PubMed
    1. Manhapra A, Stefanovics E, Rosenheck R. Initiating opioid agonist treatment for opioid use disorder nationally in the Veterans Health Administration: who gets what? Subst Abus. 2020;41(1):110–120. doi: 10.1080/08897077.2019.1640831. - DOI - PubMed

Publication types