Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.
BACKGROUND
Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings.


OBJECTIVE
To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program.


METHODS
This was an observational study using patient registry.


METHODS
The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics.


RESULTS
We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits.


RESULTS
While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems.


CONCLUSIONS
Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.
Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA. yfcuw@uw.edu.
Ya-Fen
YF
Chan
Department of Biostatistics, School of Public Health, Rutgers University, Newark, NJ, USA.
Shou-En
SE
Lu
Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA.
Bill
B
Howe
School of Architecture, Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Hendrik
H
Tieben
Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Theresa
T
Hoeft
Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Jürgen
J
Unützer
D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000379:methods / Q000458:organization & administration; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D019037:Urban Health Services / Q000458:organization & administration*; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
primary health care; rural–urban; substance screening and monitoring