Clinician screening and treatment of alcohol, drug, and mental problems in primary care: results from healthcare for communities.
OBJECTIVE
We sought to estimate national rates of screening and treatment of alcohol, drug, and mental (ADM) problems in primary care.


METHODS
This was a cross-sectional survey administered from 1997 to 1998.


METHODS
Our study included a nationally representative household probability sample of 7301 primary care patients.


METHODS
We used patient self-reports from a telephone survey to estimate rates of screening and treatment of common ADM problems, to examine the types of screening and treatment received, and to investigate adherence with treatment recommendations. Covariates included measures of ADM conditions, physical health, and sociodemographic indicators.


RESULTS
Among adult primary care patients, 38.6% (95% confidence intervals [CI] 37.2-40.0) reported clinician screening for an ADM problem. Alcohol or drug screening occurred more frequently (28.3%; 95% CI 27.0-29.6) than screening for depression and anxiety (21.2%; 95% CI 20.1-22.2). Among those screened, 30.1% (95% CI; 27.8-32.4) reported ADM treatment in primary care. Medications (16.4%; 95% CI 14.3-18.5) and counseling (18.2%; 95% CI 16.1-20.3) were the most common treatments. Rates of screening were higher among individuals with ADM disorders, the young and middle aged, and the college educated. Treatment rates were higher among individuals with ADM disorders.


CONCLUSIONS
Substantial effort is expended screening and treating common ADM problems in primary care, and these efforts are targeted towards those with ADM disorders. However, only about half of individuals with an ADM disorder report being screened, and among this group, about 60% report receiving any treatment.
Edlund
Mark J
MJ
VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, North Little Rock, Arkansas, USA. edlundmarkj@uams.edu
Unützer
Jürgen
J
Wells
Kenneth B
KB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014481:United States
D000928:Antidepressive Agents