More often may be better: Annual vs repeated substance use screening in primary care

Background: Identification of patients using drugs or alcohol at risky levels is a primary care challenge. The SBIRT model increases identification of substance use among patients, and current guidelines recommend annual screening. Objective: The goal was to examine whether repeat screening would lead to additional use disclosure, and to investigate characteristics of those who do not initially report substance use. Methods: Adult patients at two family medicine practices were administered the two recommended SBIRT screening questions during triage at every clinic visit. Results: During the 18-month study period, 4,007 patients were screened and 2,607 had at least one subsequent visit. Of those with multiple visits, 11% (n=296) screened positive initially. However, an additional 115 patients (5% of all patients; 28% of all eventual positive screens) screened positive at a subsequent visit. Those who initially reported no substance use did not differ significantly from those who reported use at the first screen in age, race, depression, or other health behaviors. However, females were more likely than males to initially report no use (32% vs 24%, χ2=3.28, p=.044), and recreational drug users were more likely than those who only abused alcohol to initially screen negative (32% vs 26%). Conclusions: Over one quarter of patients positive for risky levels of alcohol and substance use were not identified until a subsequent clinic visit. With minimal additional time expenditure, screening primary care patients at every visit may substantially increase the number of patients identified who may benefit from brief intervention or substance use treatment.