Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural–Urban Variations

• Published in: Journal of general internal medicine : JGIM Vol. 31; no. 2; pp. 215 - 222
• Main Authors: Chan, Ya-Fen, Lu, Shou-En, Howe, Bill, Tieben, Hendrik, Hoeft, Theresa, Unützer, Jürgen
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2016; Springer Nature B.V
• Subjects: Adolescent; Adult; Community involvement; Community Mental Health Services - methods; Community Mental Health Services - organization & administration; Community participation; Diagnosis, Dual (Psychiatry) - statistics & numerical data; Drug abuse; Drug use; Female; Follow-Up Studies; Health care; Health Services Accessibility - statistics & numerical data; Humans; Internal Medicine; Male; Mass Screening - methods; Mass Screening - organization & administration; Medical screening; Medicine; Medicine & Public Health; Mental disorders; Mental health; Middle Aged; Monitoring; Original Research; Patients; Primary care; Primary Health Care - organization & administration; Rural areas; Rural Health Services - organization & administration; Rural populations; Shortages; Substance Abuse Detection - methods; Substance use; Substance-Related Disorders - diagnosis; Substance-Related Disorders - epidemiology; Substance-Related Disorders - therapy; Urban areas; Urban Health Services - organization & administration; Washington - epidemiology; Young Adult; substance screening and monitoring; primary health care; rural–urban
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-015-3488-y

ABSTRACT BACKGROUND Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. OBJECTIVE To examine rural–urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. DESIGN This was an observational study using patient registry. SUBJECTS The study included adult enrollees ( n  = 15,843) with a mental disorder from 133 participating community health clinics. MAIN OUTCOMES We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. KEY RESULTS While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. CONCLUSIONS Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural–urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.