Why Substance Use Screening Frequency Matters in Adult Primary Care.

BACKGROUND: Evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time. METHODS: Quantitative data were obtained from seven primary care sites implementing SBIRT, with patients who were screened twice using the Drug Abuse Screening Test, US Alcohol Use Disorders Identification Test, or the Alcohol, Smoking, and Substance Involvement Screening Test and experienced any risk category change (n = 1,364). Patients were 49% male, 51% female, 81% White, and 14% Black. An intercept-only generalized estimating equation model tested whether category changes between screen one and screen two were statistically significant. RESULTS: The average number of months between screenings for those experiencing a risk category change was 9.01 with a range of 0 to 46 months. There was a statistically significant change between screening one and screening two (P > 0.001), with 44% undergoing a decrease in risk category and 56% undergoing an increase in risk category. Of those undergoing an increase in risk category, 91% moved from a negative/low risk category to a positive/higher risk category. CONCLUSIONS: Results suggest that frequent screening policies may improve identification of substance use risk category changes. The results act as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection.

Developing a competency-based educational structure within clinical and translational science.

In the emerging field of clinical and translational science (CTS), where researchers use both basic and clinical science research methodologies to move discoveries to clinical practice, establishing standards of competence is essential for preparing physician-scientists for the profession and for defining the field. The diversity of skills needed to execute quality research within the field of CTS has heightened the importance of an educational process that requires learners to demonstrate competence. Particularly within the more applied clinical science disciplines where there is a multi- or interdisciplinary approach to conducting research, defining and articulating the unique role and associated competencies of a physician-scientist is necessary. This paper describes a systematic process for developing a competency-based educational framework within a CTS graduate program at one institution.

Advancing knowledge and research: developing a doctoral program in clinical and translational science.

In an emerging field, such as clinical and translational science, questions of purpose and educational philosophy are crucial to consider as programs, competencies, and milestones are developed and become generally accepted as broad national standards. This article outlines issues to be taken into account as curricula are planned, implemented, and evaluated. It also discusses how philosophy, competencies, and assessments, including milestones, must be intertwined purposefully, with careful attention paid to the integration of knowledge, skills, and attitudes.