Saunders E, Moore S, Gardner T, et al. (2019). Screening for substance use in rural primary care: A qualitative study of providers and patients. Journal of General Internal Medicine. 34(12): 2824-2832. doi: 10.1007/s11606-019-05232-y
Researchers recruited 22 adult patients and 43 providers from three federally qualified health centers in rural Maine to participate in a qualitative study of current practices, barriers, and recommendations for implementing substance use screening in rural primary care. Patient recruitment (n = 22) occurred through clinic flyer advertisements and waiting room handouts. Researchers recruited primary care physicians (PCPs) (n = 21) and medical assistants (MAs) (n = 22) via email. Twelve researcher-led focus groups (6 with patients, 3 with PCPs, 3 with MAs) assessed attitudes and group norms around screening feasibility and preferences. Researchers also conducted individual interviews with PCPs (n = 10), guided by the Knowledge to Action (KTA) Framework. Researchers coded and conducted sub-theme analyses of focus group and interview transcripts using standard consensus-based qualitative methods. Across all three clinics, systematic screening for substance use with validated screening tools did not occur, though a majority of patient and provider participants considered screening for substance use critical. Most participants favored self-administered screening on a tablet computer, and all participant groups noted concerns related to electronic health record (EHR) privacy. Patients reported significant patient-provider relationship barriers (e.g. trust, difficult substance use discussions, disclosure consequences), while providers identified logistical concerns (e.g. felt unprepared to address screening results, insufficient time, inadequate training). Electronic screening may help to 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 health record privacy.