MIAMI — A one-page instrument to screen and identify adolescents at risk for alcohol use can be easily implemented in a primary care setting, although reimbursement and additional counseling time are concerns, Dr. John Femino said at the annual conference of the American Society of Addiction Medicine.
The focus on primary care physicians to screen and intervene regarding adolescent alcohol use and other behavioral issues is an important shift,” said Dr. Femino, an internist who is the medical director of a detoxification and recovery center in North Kingstown, R.I. It makes sense because “primary care physicians are seeing every kid in every school district we see.”
Rhode Island has led the United States for 4 consecutive years as the state with the highest drinking-related deaths among teenagers, mostly associated with motor vehicle accidents. “This project came out of a need in the community. A primary care task force group reached out to physicians for help,” Dr. Femino said.
The South County Physicians' Initiative Behavioral Health Screening (BHS) program includes a one-page, self-administered instrument specifically designed for busy primary care settings. Patients or a parent must sign a permission form, and they also receive a primary prevention educational package. Physicians can quickly score the screening instrument during the visit.
In a preliminary study, 886 patients aged 12–21 years were screened over 3 months at one of four private practices in Rhode Island. Results support its efficacy. “Everyone could do it. The identification went up,” Dr. Femino said.
Although the screen is rapid, most providers—once they identified a child in trouble—said they spent additional time at the same visit counseling the patient. “Just think of your well-child visits doubling in length,” said Dr. Femito.
A total of 36% screened positive for at least one behavioral concern, and 25%–-both boys and girls—checked off and met criteria for an eating disorder.
Although screening is effective, there are barriers to effectively addressing alcohol use problems in teenagers. Among physicians, those barriers include time constraints, reimbursement and “a fear of ticking off the parent.” Among children, concerns focus on confidentiality, and among parents, the belief that alcohol and drug use is part of normal teenage experimentation presents a barrier to adolescent screening programs. Parents also might fear the stigma associated with substance abuse.
Another concern is that insurance labeling via the Medical Information Bureau would create lifelong stigmatization by placing the teenager in a high-risk category for health, disability, or life insurance eligibility or premium ratings, Dr. Femino said. “We were very sensitive as to which billing codes we could use to avoid this. It is possible to figure out how to get paid for prevention and counseling. There are new codes, but it's tricky.”