Interventions in Primary Care Are Effective

What is the secret to conducting effective yet inexpensive screening and brief intervention for substance use in primary care settings? How has care for addictions found a seat at the table of the primary care patient-centered medical home? Norman Wetterau, MD, FASAM, Addiction Medicine Specialist and Family Physician, Tri-County Family Medicine, Dansville, N.Y., discussed key insights to such questions that he and two other primary care and addiction medicine physicians presented during Thursday’s Component Session 2 “Addressing Substance Use Disorders in Primary Care: How Can We Improve?”

“Each year, the ASAM Primary Care and Family Medicine Work Group conducts a workshop to report on substance use issues that arose during the year to get input from the entire group,” said Dr. Wetterau, Component Session 2 organizer. “This year, screening and brief intervention, and the patient-centered medical home were selected as topics for this session.”

Session speakers J. Paul Seale, MD, Professor and Director of Research, the Department of Family Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, Macon, Ga., and Abdel Fahmy, MD, physician and administrator, DuPage Medical Group, Chicago, shared their considerable expertise in providing screening, brief intervention, and referral to treatment (SBIRT) in primary care settings in the absence of reimbursement for it. Dr. Seale has been involved in SBIRT programs throughout the South and Dr. Fahmy works with federally qualified health centers in medically underserved, low-income metropolitan Chicago neighborhoods.

“A key point they made is that when you don’t have a grant to fund SBIRT, it’s difficult to implement it,” Dr. Wetterau said. “Still without funding, flexible and simple approaches make SBIRT possible in primary care practices.”

One efficient approach involves delegating screening questions and full substance use audits of patients to medical assistants. Then the physician can provide expert review of the audit and a brief intervention, if necessary.

“This system is simple and it works,” Dr. Wetterau said. “Many primary care physicians have struggled with setting up SBIRT in their practices without grant money to fund it, so this effective, less expensive method is a feasible alternative.”

During the session, Dr. Wetterau discussed his service to the Patient-Centered Primary Care Collaborative (PCPCC), a large national organization of physicians, medical organizations, insurance companies, and employers collaborating to develop the Patient Centered Medical Home. He was appointed in January to the Care Delivery and Integration Center Leadership Team that includes 15 organizations, including ASAM. The team’s objective is to provide programs and assistance to help transform primary care practices into patient-centered medical homes.

“We wanted to make sure that addiction medicine is integrated into these primary care homes,” he said. “We have had some successes with this endeavor.”

For example, the non-profit National Committee for Quality Assurance (NCQA) now requires medical homes to ask about drug and alcohol use. Dr. Wetterau also is working on this team to provide links to primary care addiction websites and to develop webinars about the potential for substance use treatment in patient-centered medical homes. Additionally, ASAM is planning a section on its website that can be linked to these sites.

“Our presence there really helps everyone realize that substance use issues are really important to the patient-centered medical home,” he said. “ASAM is helping to suggest resources and find speakers for the webinars.”