Clinician Screening and Treatment of Alcohol, Drug, and Mental Problems in Primary Care

Results from Healthcare for Communities

Published in: Medical Care, v. 42, no. 12, Dec. 2004, p. 1158-1166

Posted on RAND.org on January 01, 2004

by Mark J. Edlund, Jurgen Unutzer, Kenneth B. Wells

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OBJECTIVE: The authors sought to estimate national rates of screening and treatment of alcohol, drug, and mental (ADM) problems in primary care. DESIGN: This was a cross-sectional survey administered from 1997 to 1998. PARTICIPANTS: Our study included a nationally representative household probability sample of 7301 primary care patients. MEASUREMENT: The authors 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.

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