scholarly journals Variation in brief treatment for substance use disorder: a qualitative investigation of four federally qualified health centers with SBIRT services

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dennis P. Watson ◽  
Monte D. Staton ◽  
Michael L. Dennis ◽  
Christine E. Grella ◽  
Christy K. Scott
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Low Cost ◽  
Health Centers ◽  
Qualitative Investigation ◽  
Brief Treatment ◽  
Federally Qualified Health Centers ◽  
Implementation Quality ◽  
Cost Treatment ◽  
Future Work

Abstract Background Brief treatment (BT) can be an effective, short-term, and low-cost treatment option for many people who misuse alcohol and drugs. However, inconsistent implementation is suggested to result in BT that often looks and potentially costs similar to regular outpatient care. Prior research is also rife with inconsistent operationalizations regarding the measurement of BT received by patients. As such, there is a need to more explicitly identify and document variations in BT practice. Methods A qualitative investigation of BT in four Federally Qualified Health Centers (FQHC) was undertaken as a sub study of a larger clinical trial. Researchers interviewed 12 staff (administrators and clinicians) involved in BT oversight, referral, or delivery within the four FQHCs. Data were analyzed following an inductive approach guided by the primary research questions. Results Findings demonstrate considerable differences in how BT was conceptualized and implemented within the FQHCs. This included a variety of ways in which BT was presented and described to patients that likely impacts how they perceive the BT they receive, including potentially not understanding they received substance use disorder treatment at all. Conclusions The findings raise questions regarding the validity of prior research, demonstrating more objective definitions of BT and fidelity checklists are needed to ensure integrity of results. Future work in this area should seek to understand BT as practiced among a larger sample of providers and the direct experiences and perspectives of patients. There is also a need for more consistent implementation, quality assurance guidelines, and standardized stage of change assessments to aid practitioners.

Substance Use Disorder Screening Capacity Lags Behind Depression Screening Capacity in Community Health Centers

2017 ◽  
Vol 48 (2) ◽  
pp. 152-164 ◽  
Author(s):  
Emily Jones ◽  
Traci Rieckmann
Keyword(s):  
Substance Use ◽  
Community Health ◽  
Substance Use Disorder ◽  
Community Health Centers ◽  
Health Centers ◽  
Screening Tools ◽  
Depression Screening ◽  
Federally Qualified Health Centers ◽  
Ehr Adoption ◽  
Standardized Screening

Despite their prevalence, screening for depression and substance use disorder (SUD) is often not routinely practiced in primary care. This study uses a survey of community health centers to identify characteristics associated with depression and SUD screening. In 2010, 76.9% of federally qualified health centers routinely screened for depression, and about half of health centers (54.1%) routinely screened for SUDs. Higher Medicaid caseload and region were associated with routine screening for both depression and SUDs. SUD screening was also associated with the percent of total staff comprised of behavioral health specialists, electronic health record (EHR) adoption, urban location, and higher uninsured caseload. Implications include the need to build SUD screening capacity, encourage the use of standardized screening tools, and monitor SUD screening capacity in health centers in the future.

Implementing a Substance Use Screening Protocol in Rural Federally Qualified Health Centers

2020 ◽  
pp. 107839032097549
Author(s):  
Blake Reddick ◽  
Karen J. Foli ◽  
Jennifer A. Coddington ◽  
Diane Hountz
Keyword(s):  
Substance Use ◽  
Rural Areas ◽  
Low Cost ◽  
Health Resources ◽  
Health Centers ◽  
Federally Qualified Health Centers ◽  
Knowledge And Attitudes ◽  
Approval Rating ◽  
Screening Protocol ◽  
Substance Involvement

INTRODUCTION In 2018, nearly 20% of Americans aged 12 years and older reported using illicit substances, with higher rates in rural areas. Federally Qualified Health Centers (FQHCs) provide health care to one in five rural Americans. However, estimates suggest that only 13.6% of patients in rural FQHCs receive substance use (SU) screening compared with 42.6% of patients in urban FQHCs. AIMS This quality improvement (QI) project aimed to improve patient quality and safety and meet Health Resources and Services Administration reporting requirements. These aims were achieved through the design and implementation of a new SU screening protocol in four FQHCs in rural Indiana. METHOD Deming’s plan–do–study–act model was used to implement QI interventions to increase SU screening rates. A new SU screening tool, the National Institute on Drug Abuse –Modified Alcohol, Smoking, and Substance Involvement Screening Testwas implemented, and staff were trained on its use. the screening, brief intervention, and referral to treatment model was used as a guiding framework. Outcome measures included a comparison of SU screening rates from the first quarter of 2019 to the first quarter of 2020, as well a pretest–posttest designed to measure staff knowledge and attitudes regarding SU. RESULTS Baseline SU screening rate in 2019 was 0.87%. This increased to 24.8% by March 2020. Additionally, posttest results demonstrated improvement from staff on all indices, and an approval rating of 77% of the new SU screening practices. CONCLUSIONS This project demonstrated that a low-cost QI intervention can increase SU screening rates in rural FQHCs, as well as improve staff knowledge and attitudes regarding SU.

scholarly journals 2570. HCV Screening Practices Among Adolescents and Young Adults in a National Sample of Federally Qualified Health Centers in the United States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S74-S74 ◽  
Author(s):  
Rachel L Epstein ◽  
Jianing Wang ◽  
Kenneth Mayer ◽  
Jon Puro ◽  
C Robert Horsburgh ◽  
...  
Keyword(s):  
United States ◽  
Substance Use ◽  
Young Adults ◽  
The United States ◽  
National Sample ◽  
Health Centers ◽  
Federally Qualified Health Centers ◽  
Screening Practices ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background The opioid crisis has been associated with an increase in hepatitis C virus (HCV) infections among 15–30 year olds. Federally Qualified Health Centers (FQHCs) provide comprehensive healthcare to diverse and underserved communities. However, little is known about HCV screening practices among adolescents and young adults seen at FQHCs across the United States. Objective. To characterize the continuum of HCV testing and care among adolescents and emerging adults in a large national sample of US FQHCs. Methods We used the OCHIN electronic medical record to create a retrospective cohort of 13 to 21 year olds who had a least 1 outpatient visit at any of 98 participating US FQHCs across 19 states from 2012 to 2017. Primary outcome was HCV testing during this timeframe. We also identified predictors of HCV screening using multivariable logistic regression adjusting for age, sex, race/ethnicity, and substance use. Results Among 269,287 youth who met inclusion criteria, 54.7% were female, 37.6% White, 33.5% Hispanic, 17.6% Black, and 11.3% other. Mean [SD] age at first HCV screening was 18.5 [2.2] years. Over the study period, 2.5% (6849/269,287) were tested for HCV and 153 (2.2%) had reactive HCV testing. Of those, 117 (76.5%) had confirmatory RNA testing and 65 (55.6%) had detectable RNA. Thirty-five percent (325/933) with ICD-9 codes for opioid-use disorder (OUD) and 8.9% (2080/23,345) with any ICD-9 code for drug use were tested for HCV. Only 10.6% (728/6,849) of individuals tested for HCV had also been tested for human immunodeficiency virus (HIV). Older age (19–21 vs. 13–15 years old at study end, aOR 5.64, 95% CI 5.13–6.19), Black race (aOR 1.88, 95% CI 1.76–2.00), and ICD-9 codes for substance-use disorder, in particular amphetamine (aOR 5.82, 5.10–6.64), opioids (aOR 3.50, 2.92–4.19), cocaine (aOR 2.90, 2.43–3.47), or cannabis (aOR 2.46, 2.31–2.62) were independently associated with HCV testing in multivariable analysis. Conclusion During the current opioid crisis, only a third of adolescents/young adults diagnosed with OUD in a large national sample of FQHCs were tested for HCV. In addition, only 10% of those tested for HCV were also screened for HIV. Initiatives are needed to increase HCV and HIV screening among at-risk youth at FQHCs. Disclosures All authors: No reported disclosures.

Evaluating the documentation of risky substance use in federally qualified health centers

2015 ◽  
Vol 156 ◽  
pp. e187 ◽  
Author(s):  
Anjani Reddy ◽  
Mani Vahidi ◽  
Nathan Cox ◽  
Heather Alden ◽  
Ronald Andersen ◽  
...  
Keyword(s):  
Substance Use ◽  
Health Centers ◽  
Federally Qualified Health Centers

scholarly journals Examining trends in substance use disorder capacity and service delivery by Health Resources and Services Administration-funded health centers: A time series regression analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242407
Author(s):  
Nadereh Pourat ◽  
Brenna O’Masta ◽  
Xiao Chen ◽  
Connie Lu ◽  
Weihao Zhou ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Low Income ◽  
Service Use ◽  
Unmet Need ◽  
Health Resources ◽  
Health Centers ◽  
Full Time ◽  
Number Of Patients ◽  
The Impact

Background The opioid epidemic and subsequent mortality is a national concern in the U.S. The burden of this problem is disproportionately high among low-income and uninsured populations who are more likely to experience unmet need for substance use services. We assessed the impact of two Health Resources and Services Administration (HRSA) substance use disorder (SUD) service capacity grants on SUD staffing and service use in HRSA -funded health centers (HCs). Methods and findings We conducted cross-sectional analyses of the Uniform Data System (UDS) from 2010 to 2017 to assess HC (n = 1,341) trends in capacity measured by supply of SUD and medication-assisted treatment (MAT) providers, utilization of SUD and MAT services, and panel size and visit ratio measured by the number of patients seen and visits delivered by SUD and MAT providers. We merged mortality and national survey data to incorporate SUD mortality and SUD treatment services availability, respectively. From 2010 to 2015, 20% of HC organizations had any SUD staff, had an average of one full-time equivalent SUD employee, and did not report an increase in SUD patients or SUD services. SUD capacity grew significantly in 2016 (43%) and 2017 (22%). MAT capacity growth was measured only in 2016 and 2017 and grew by 29% between those years. Receipt of both supplementary grants increased the probability of any SUD capacity by 35% (95% CI: 26%, 44%) and service use, but decreased the probability of SUD visit ratio by 680 visits (95% CI: -1,013, -347), compared to not receiving grants. Conclusions The significant growth in HC specialized SUD capacity is likely due to supplemental SUD-specific HRSA grants and may vary by structure of grants. Expanding SUD capacity in HCs is an important step in increasing SUD access for low income and uninsured populations broadly and for patients of these organizations.

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