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Screening for Substance Use in Rural Primary Care: A Qualitative Study of Providers and Patients


Saunders EC, Moore SK, Gardner T, et al.


Researchers examined barriers to screening for substance use in rural primary care settings and recommendations for implementing screening in rural federally qualified health centers (FQHCs).


Researchers recruited 22 patients through clinic flyer advertisements and waiting room handouts, 22 medical assistants (MAs) and 21 primary care physicians (PCPs) via email, to a qualitative study of tobacco, alcohol, and drug use screening in rural Maine primary care settings. Focus groups lasted approximately 45 minutes. Researchers conducted 60-minute interviews with select PCPs. Interview guides were based on the Knowledge to Action (KTA) Framework. Researchers recorded and transcribed focus groups and interviews, then used content analysis to examine themes from focus group and interview transcripts based on domains in the KTA Framework.

  • Across all clinics, systematic screening for substance use with validated screening tools did not occur, though all participant groups believed that screening was important.
  • Most participants favored self-administered screening on a tablet, though all participant groups noted disadvantages to both electronic and paper screening.
  • Patients reported significant patient-provider relationship barriers (e.g. trust, difficult substance use discussions, disclosure consequences), while providers identified logistical screening concerns (e.g. felt unprepared to address results, insufficient time, inadequate training).
  • Both patients and providers consider screening for substance use critical.
  • Electronic screening may overcome barriers related to patient disclosure discomfort and screening administration logistics.
  • Future research could examine provider training needs and identify methods to educate patients about electronic screening privacy.
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Saunders EC, Moore SK, Gardner T, et al. Screening for substance use in rural primary care: A qualitative study of providers and patients. J GEN INTERN MED. 14 August 2019. doi: 10.1007/s11606-019-05232-y