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APHA Scientific Session and Event Listing

Paul Postiglione, MSW¹, Nancy Claiborne, PhD², Lynn Videka, PhD², Allan Finkelstein, PhD¹, Patricia McDonnell, MSW², and Robin Krause, BA¹. (1) Chemical Dependency Rehabilitation Program, Veterans Administration Medical Center, 113 Holland Avenue, Albany, NY 12208, 518-626-5395, paul.postiglione@med.va.gov, (2) School of Social Welfare, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222

Objectives: Integrated care facilitates communication between behavioral health and primary care, however referrals for evaluation and treatment in one VA occurred with less than 3 percent rate for patients screened and identified with an alcohol problem. An exploratory study identifying system-wide barriers and incentives for evaluation and treatment of patients with alcohol problems is being conducted. It also aims to identify and reduce system-wide factors that may impede referrals to a planned pre-contemplative patient group sponsored by the Chemical Dependency Rehabilitation Program (CDRP). The study's first stage is completed.

Methods: The study's first stage conducted interviews at six primary care sites with MD and nurse practitioner primary care providers (PCPs), nurses, behavioral health providers (BHPs), and team clerks. Interviews provided qualitative data concerning clinic practice, provider beliefs and practices regarding alcohol screening and follow-through. Sites represented rural, urban and small cities.

Results: 31 interviews were conducted (11 nurses, 9 PCPs, 8 BHPs, 3 clerks). NVIVO qualitative software analyzed transcribed data. Researchers identified themes regarding relevant barriers and facilitating factors.

Conclusions: Major themes were PCPs rely on electronically referring patients to BHPs, occasionally directly to CDRP. However, clinics' BHPs typically do not perceive patients with alcohol problems as their primary responsibility and rely on electronic referral or “warm hand off” to CDRP. PCPs expressed concern about patients with alcohol problems, but felt helpless addressing treatment resistance and have little expectation that patients will follow-through. A system for tracking patient follow-through from referral to CDRP exists, yet is poorly understood and underutilized.

Learning Objectives:

• Attendees will understand the concept of integrated behavioral health in primary care.
• Attendees will understand that under-identification and under-treatment of substance use disorders results in serious negative health consequences for the person and is costly to the VA and society.
• Attendees will identify common co-morbid mental health and physical conditions related to substance abuse disorder presenting in the VA.
• Attendees will identify important systems issues of clinic practice and provider beliefs and practices regarding alcohol screening and follow-through.

Keywords: Alcohol Problems, Primary Care

Presenting author's disclosure statement:

Any relevant financial relationships? No