Screening for Youth Substance Use

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Kaiser Permanente

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

9084 Participants Needed

Trial Summary

What is the purpose of this trial?

This study evaluates the implementation and effectiveness of two modalities of Screening, Brief Intervention and Referral to Treatment (SBIRT) to reduce adolescent alcohol and other drug (AOD) use in a large pediatrics clinic.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment involving a Behavioral Medicine Specialist and Primary Care Physician for youth substance use?

Research suggests that primary care visits, where doctors screen young people for substance use and offer brief interventions, can help reduce risky substance use. Although implementation is limited, these screenings and interventions have the potential to benefit young people's health on a larger scale. ^{1 2 3 4 5}

Is the treatment generally safe for humans?

The research articles focus on adverse events in primary care and medication reactions, but they do not provide specific safety data for the treatment in question. However, they highlight the importance of avoiding adverse events by following medical guidelines. ^{6 7 8 9 10}

How is the Primary Care Physician treatment for youth substance use different from other treatments?

The Primary Care Physician treatment for youth substance use is unique because it involves structured screening and brief interventions during regular health check-ups, which are not widely implemented despite being recommended. This approach allows for early identification and intervention in a familiar setting, unlike other treatments that may not integrate screening into routine care. ^{1 4 5 11 12}

Eligibility Criteria

This trial is for adolescent primary care providers and their patients aged 12-18 at a specific pediatric clinic. It aims to assess methods to reduce youth alcohol and drug use. Providers outside this clinic or patient records not from this site are excluded.

Inclusion Criteria

All adolescent primary care providers at the pediatric primary care clinic will be included

I am between 12 and 18 years old and my health records are at a pediatric care facility.

Exclusion Criteria

Any adolescent primary care providers not practicing at the pediatric primary care clinic research site will be excluded

Adolescents electronic records who are not part of the research site pediatric clinic will be excluded.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

Initial well-visit

1 visit (in-person)

Intervention

Screening, Brief Intervention, and Referral to Treatment (SBIRT) delivered by either Primary Care Physicians or Behavioral Medicine Specialists

Within 14 days of assessment

1-2 visits (in-person)

Follow-up

Participants are monitored for AOD use and abstinence, and specialty treatment initiation

Up to 2 years post-intervention

Periodic assessments (in-person or virtual)

Treatment Details

Interventions

• Behavioral Medicine Specialist
• Primary Care Physician

Trial Overview The study is testing two approaches of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in a pediatrics clinic setting to see which is more effective at reducing alcohol and other drug use among adolescents.

Participant Groups

Group I: Primary Care Physician Experimental Treatment 1 Intervention

If the adolescent is identified at risk for substance use, the screening and brief intervention referral to treatment delivered is by the primary care physician

Group II: Behavioral Medicine Specialist Experimental Treatment 1 Intervention

If the adolescent is identified at risk for substance use, the screening and brief intervention referral to treatment delivered by the behavioral medicine specialist

Group III: Usual Care Active Control 1 Intervention

Care is administered as usual

Who Is Running the Clinical Trial?

Kaiser Permanente

Lead Sponsor

Trials

563

Recruited

27,400,000+

Findings from Research

In a study analyzing 2557 patient records, 72.7% of do-not-do recommendations (DNDs) were ignored, leading to 69 avoidable adverse events (AAEs) in 1307 patients, indicating a significant risk associated with disregarding these guidelines.

Most AAEs were minor and temporary, with a higher occurrence in older adults (5.7% in patients aged 65 and older), highlighting the potential safety risks of low-value medical practices in primary care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting. Mira, JJ., Carrillo, I., Pérez-Pérez, P., et al.[2023]

In a study of 1689 pediatric patients, 14% experienced an adverse drug event (ADE), with 23% of those being preventable, highlighting a significant concern in medication safety for children.

Children receiving multiple prescriptions were found to be at a higher risk (odds ratio of 1.46) for preventable ADEs, indicating the need for better communication and monitoring in healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk factors in preventable adverse drug events in pediatric outpatients. Zandieh, SO., Goldmann, DA., Keohane, CA., et al.[2008]

References

1. England pubmed.ncbi.nlm.nih.gov

A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Excessive substance use screening to encourage behaviour change among young people in primary care: Pilot study in preparation for a randomized trial. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

The "Six T's": barriers to screening teens for substance abuse in primary care. [2018]

4. United States pubmed.ncbi.nlm.nih.gov

Results of a statewide survey of adolescent substance use screening rates and practices in primary care. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Primary care follow-up plans for adolescents with substance use problems. [2021]

6. Spain pubmed.ncbi.nlm.nih.gov

[Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity]. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting. [2023]

8. Spain pubmed.ncbi.nlm.nih.gov

[Something more about adverse reactions to medications]. [2016]

9. United States pubmed.ncbi.nlm.nih.gov

Risk factors in preventable adverse drug events in pediatric outpatients. [2008]

10. United States pubmed.ncbi.nlm.nih.gov

Adverse drug events in pediatric outpatients. [2013]

11. United States pubmed.ncbi.nlm.nih.gov

Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial. [2021]

12. United States pubmed.ncbi.nlm.nih.gov

Rates and predictors of substance use in pediatric primary care clinics. [2022]