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

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DESCRIPTION (provided by applicant): This application responds to the National Institute on Alcohol Abuse and Alcoholism's Program Announcement PA-05-139 Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse, and its goal of understanding "factors that affect the delivery of alcohol or drug abuse prevention, treatment, and related services: social factors, personal behaviors and attributes, financing, organization, management; and health technologies." In particular, we focus on expanding primary care's role in prevention and treatment of alcohol and other drug (AOD) problems. We address the gap in research on incentives and barriers for adolescent primary care providers to make AOD use a health care priority. Our aim is to identify the factors associated with screening practices and management of youth AOD use in order to integrate these activities more fully into primary care. We have the opportunity to study this in a large, heterogeneous managed care health plan. We use a model which examines the influence of provider, panel/patient and organizational characteristics on primary care screening and follow-up services. We propose an on-line survey of primary care providers with adolescent panels to investigate their AOD screening practices, and their perceptions of barriers and enabling factors to screening and follow-up interventions. The study makes use of both provider self-report and health plan electronic databases of screening behavior, and provider and panel characteristics. We also use the health plan's electronic medical record and other automated databases to examine reported and actual screening rates, as well as provider practices after the identification of AOD use. We collect data on organizational characteristics across the region's 48 facilities. Our multivariate analytic model examines facility differences in screening rates and accounts for the clustering of providers within facilities as appropriate. We also propose to conduct interviews with health plan administrators and chiefs, of pediatrics departments to explore policies and procedures as they impact development and dissemination of screening practices. Identifying barriers and incentives to screening and management of AOD problems can heighten integration of AOD identification and services within primary care. Early identification of AOD problems can prevent the development of medical, chemical dependency, and psychiatric problems.