News from the Node

Alcohol and drug use disorders are among the top ten causes of preventable death in the United States, and only a small fraction of individuals with unhealthy substance use are served by the specialty addiction treatment system.(1-4)  People with substance use disorders (SUDs) are rarely screened, assessed or treated in mainstream healthcare settings such as primary care clinics and other office-based practices. While mainstream settings represent an ideal place and context to identify SUDs and initiate treatment, efforts to integrate SUD services have largely fallen short.

One in ten Maine residents report prescription opioid misuse in their lifetime. Physicians in Maine write the most prescriptions for long-term, extended release opioid medications in the US, more than doubling the national average. At the same time, Maine is one of the states that did not expand Medicaid under the Affordable Care Act, leaving resources for SUD care particularly limited. All 16 counties in Maine have at least one—and in many cases multiple—Medically Underserved Areas/Populations as defined by the Federal Government. The Census Bureau designated Maine as the most rural state, with more than 61% of its residents living in rural areas. Maine has only 3 areas considered urban (>50,000 people). With a population of 1.3 million living in geographically spread out locations, providing quality, accessible services is a significant challenge.

Penobscot Community Health Care (PCHC), partners of the Northeast Node from Bangor, Maine, are teaming up with the Greater New York Node of the National Drug Abuse Treatment Clinical Trials Network to evaluate an electronic health record-based screening and treatment/referral process for primary care patients at three PCHC sites. This new study is part of CTN-0062-Ot-A1: A Phased-Implementation Feasibility and Proof-of-Concept Study to Assess Incorporating the NIDA CTN Common Data Elements (CDEs) into the Electronic Health Record (EHR) in Large Primary Care Settings (“CDE-EHR-PC” Study).

For the past four years, the Greater New York Node, in partnership with Emmes (the CTN’s data and statistics coordination contractor), has led a coordinated effort to develop a library of common data elements (CDEs) for Electronic Health Records (EHRs) in large primary care settings.(9) The goal is to incorporate addiction-specific screening and assessment CDEs into a widely used EHR, develop EHR-integrated clinical decision support (CDS) to maximize the clinical utilization of screening results, and facilitate referrals to addiction treatment through the EHR to link those with moderate to severe disorders to specialty care.

As an ancillary study to the main trial, our partners at PCHC aim to explore and evaluate the process and impact of implementing the Tobacco, Alcohol, Prescription medications, and other Substance (TAPS) Tool in three primary care clinics/practices. The TAPS Tool is a recently validated measure produced from CTN-0059 (Tobacco, Alcohol, Prescription Medications, and Substance Use/Misuse Brief Screen/Assessment Tool (TAPS Tool)).

The Northeast Node is excited to partner with Greater New York in this study; there is now an exceptional opportunity to facilitate integrated care for SUD by leveraging electronic health records in primary health care settings like the federally-qualified health center (FQHC) in rural Maine. This has the potential to enhance meaningful identification and treatment, coordinate care, reduce the impact of substance use on other chronic medical conditions (e.g. hypertension, diabetes, HIV/HCV), and to reduce morbidity, mortality and healthcare costs. The addition of a FQHC site in rural Maine will greatly add to our knowledge about optimizing the integration of screening into primary care, and enhance the generalizability of our findings from the parent study.

References:

1. Robert Wood Johnson Foundation and Schneider Institute for Health Policy. Substance abuse: The nation’s number one health problem2001 May 28, 2013. Available from: http://www.rwjf.org/files/publications/other/SubstanceAbuseChartbook.pdf.
2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA : the journal of the American Medical Association. 2004 Mar 10;291(10):1238-45. PubMed PMID: 15010446. Epub 2004/03/11. eng.
3. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA : the journal of the American Medical Association. 1993 Nov 10;270(18):2207-12. PubMed PMID: 8411605. Epub 1993/11/10. eng.
4. Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2011 National Survey on Drug Use and Health: National Findings2012 February 5, 2010; Office of Applied Studies(HHS Publication No. SMA 12-4713). Available from: http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.htm#7.3.
5. Nilsen P. Brief alcohol intervention–where to from here? Challenges remain for research and practice. Addiction. 2010 Jun;105(6):954-9. PubMed PMID: 20121717. Epub 2010/02/04. eng.
6. Nilsen P, Aalto M, Bendtsen P, Seppa K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review. Scand J Prim Health Care. 2006 Mar;24(1):5-15. PubMed PMID: 16464809. Epub 2006/02/09. eng.
7. Kaner E. Brief alcohol intervention: time for translational research. Addiction. 2010 Jun;105(6):960-1; discussion 4-5. PubMed PMID: 20659054. Epub 2010/07/28. eng.
8. Babor TF, Higgins-Biddle JC. Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction. 2000 May;95(5):677-86.
9. Ghitza UE, Gore-Langton RE, Lindblad R, Shide D, Subramaniam G, Tai B. Common data elements for substance use disorders in electronic health records: the NIDA Clinical Trials Network experience. Addiction. 2013 Jan;108(1):3-8. PubMed PMID: 22563741. Epub 2012/05/09. eng.