Implementing Screening for Cannabis and Other Drug Use Disorders in Primary Care: Impact on Diagnosis and Treatment

Summary

Our proposed evaluation study is designed to evaluate the impact of a recently completed stepped wedge cluster randomized trial, conducted at Kaiser Permanente Washington (KPWA), of an intervention to improve care and management of patients with drug use disorders (DUDs) in primary care (Aim 1). We will also explore the reasons for any apparent gaps in DUD care by analyzing clinicians' free-text encounter notes using manual chart review, natural language processing (NLP), and/or NLP-assisted manual chart review, as appropriate (Aim 2).

Specific Project Aims are as follows:

Aim 1 The primary research question we address in Aim 1 is whether routine screening for drug use disorders in primary care (PC) settings increases DUD treatment. We define DUDs as including opioid use disorders (OUD), cannabis use disorders (CUD), and other non-alcohol drug use disorders (OTH). Previously published analyses indicate that the 22 PC clinics in this trial sustained very high rates of screening (88%) and a 3-clinic DUD pilot study suggested that this screening resulted in increased diagnosis of CUD and increased treatment of DUDs in general, even at relatively low observed rates of PC-based screening and assessment.

Aim 2

The overall goal of Aim 2 is to expand our understanding of gaps in DUD diagnosis and treatment that persist-despite implementation of high rates of PC screening and assessment for SUDs-using rich information available only in free-text chart notes. Through analysis of relevant chart notes Aim 2 of this project will descriptively characterize gaps in DUD diagnosis and DUD treatment (i.e., instances where information in a patient's record suggests a DUD could be diagnosed but no diagnosis is present, or a new diagnosis suggest treatment is indicated but no evidence of treatment is present), and characterize reasons for DUD care gaps.

Conditions

• Cannabis-Related Disorder
• Cannabis Abuse
• Drug Abuse
• Drug Use Disorders
• Opioid Use Disorder
• Opioid Abuse
• Substance Abuse
• Substance Use Disorders

Interventions

OTHER

Care Delivery Improvement Intervention

KPWA clinical leaders and clinicians in each clinic implemented all aspects of the care delivery improvement intervention, including screening, assessment, and shared decision-making followed, as appropriate, by treatment. The implementation strategy, which was refined during the pilot phase, included: 1. Identification of a clinical champion and local implementation team 2. Participatory design 3. Training of primary care providers and medical assistants 4. Use of EHR clinical decision support tools 5. Weekly facilitated local implementation team meetings 6. Performance monitoring with feedback, including monthly meetings with the local implementation team and clinic leaders 7. Learning sessions for primary care providers during implementation 8. Social worker use of an EHR registry with weekly supervision 9. Use of a video and informational handouts to shift attitudes and reduce stigma associated with unhealthy substance use

Sponsors & Collaborators

• National Institute on Drug Abuse (NIDA)

  collaborator NIH

• Kaiser Permanente

  lead OTHER

Principal Investigators

• David S Carrell, PhD · Kaiser Permanente

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Model

CROSSOVER

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2015-01-31

Primary Completion

2024-04-30

Completion

2024-07-31