title: Screening for unhealthy alcohol and other drug use by health educators: do primary care clinicians document screening results?
abstract: OBJECTIVE
  Health educators are increasingly being used to deliver preventive care including screening and brief intervention (SBI) for unhealthy substance use (SU) (alcohol or drug). There are few data, however, about the "handoff" of information from health educator to primary care clinician (PCC). Among patients identified with unhealthy SU and counseled by health educators, the objective of this study was to examine (1) the proportion of PCC notes with documentation of SBI and (2) the spectrum of SU not documented by PCCs.
  
  
  METHODS
  Before the PCC-patient encounter, health educators screened for SU, assessed severity (Alcohol, Smoking, and Substance Involvement Screening Test), and counseled patients. They also conveyed this information to the PCC before the PCC-patient encounter. Researchers reviewed the electronic medical record for PCC documentation of SBI performed by the health educator and/or the PCC.
  
  
  RESULTS
  Among patients with the health educator-identified SU, only 69% (342/495) of PCC notes contained documentation of screening by the health educator and/or the PCC. Documentation was found in all encounters with patients with likely dependent SU, but only 62% and 59% of encounters with patients with risky alcohol and drug use, respectively. Documentation of cocaine or heroin use was higher than that of alcohol or marijuana use but still not universal. Although all SU-identified patients had received a brief intervention (from a health educator and possibly a PCC), only 25% of PCC notes contained documentation of a brief intervention.
  
  
  CONCLUSIONS
  Among patients screened and counseled by health educators for unhealthy SU, SBI was often not documented by PCCs. These results suggest that strategies are needed to integrate SBI by primary care team members to advance the quality of care for patients with unhealthy SU.
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA. theresa.kim@bmc.org
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Natalie
authors.initials: N
authors.lastname: Kretsch
authors.forename: Alissa
authors.initials: A
authors.lastname: Cruz
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Shanahan
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Alford
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control / Q000523:psychology; D001900:Boston; D003695:Delivery of Health Care / Q000458:organization & administration*; D037001:Directive Counseling / Q000379:methods / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D040441:Health Educators; D006301:Health Services Needs and Demand; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D058007:Physicians, Primary Care; D011614:Psychotherapy, Brief / Q000379:methods / Q000706:statistics & numerical data; D015813:Substance Abuse Detection / Q000379:methods / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy