Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

Kaiser Permanente

Status: Active, not recruiting

Conditions: Substance Related Disorders

Treatments: Behavioral: Primary Care Physician; Behavioral: Behavioral Medicine Specialist

Study type: Interventional

Funder types: Other

Identifiers

NCT02408952

11-07796

Details and patient eligibility

About

This study evaluates the implementation and effectiveness of two modalities of Screening, Brief Intervention and Referral to Treatment (SBIRT) to reduce adolescent alcohol and other drug (AOD) use in a large pediatrics clinic.

Full description

Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize 45 Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care; 2) SBIRT delivered by PCPs; and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiation), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed interventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data.

Enrollment: 9,084 patients

Sex: All

Ages: 12 to 80 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

There are two study populations as described below thus the large age limit range.

Inclusion Criteria:

• All adolescent primary care providers at the pediatric primary care clinic will be included.
• All adolescent patient electronic records, ages 12-18, at the pediatric primary care will be examined.

Exclusion Criteria:

• Any adolescent primary care providers not practicing at the pediatric primary care clinic research site will be excluded.
• Adolescents electronic records who are not part of the research site pediatric clinic will be excluded.

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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9,084 participants in 3 patient groups

Primary Care Physician

Experimental group

Description:

If the adolescent is identified at risk for substance use, the screening and brief intervention referral to treatment delivered is by the primary care physician

Treatment:

Behavioral: Primary Care Physician

Behavioral Medicine Specialist

Experimental group

Description:

If the adolescent is identified at risk for substance use, the screening and brief intervention referral to treatment delivered by the behavioral medicine specialist

Treatment:

Behavioral: Behavioral Medicine Specialist

Usual Care

No Intervention group

Description:

Care is administered as usual