Proactive Engagement of Patients with Alcohol and Drug Use Disorders in Primary Care: A Social Work Innovation Project

Background and Purpose: Only about 1 in 10 patients with alcohol or drug use disorders (AOD) engage in treatment. Yet most patients regularly access primary care (PC), where evidence-based treatments can be provided.  A pilot study in three PC clinics in one integrated system evaluated the feasibility of social workers (LICSWs) to increase engagement in evidence-based treatment for AOD.  Specifically, LICSWs proactively called patients with AOD diagnoses identified in an electronic health record (EHR) registry to engage them in care.  LICSWs provided assessment and motivational interviewing (MI), shared decision-making (SDM), and brief action planning.  LICSW training included: a two-hour training in MI skills; SDM; brief action planning; evidence-based treatment options, including pharmacotherapy; and use of a population-based registry, as well as weekly telephone and web-based group supervision meetings where LICSWs discussed cases with clinical experts in addictions and MI.  This report describes LICSW registry use across three sites and LICSW experience of proactively calling and engaging patients with AOD diagnoses.

Methods: EHR registries included patients ≥18 years old with recent AOD diagnoses, identified via EHR documentation in each of three PC clinics March 2015 – February 2016.  Registry use was defined as any documentation within the registry by LICSWs.  We gathered qualitative findings of LICSW experience with the registry as part of formative evaluation.

Results: A total of 1,570 patients had recent AOD diagnoses during the report period.  The number of patients with AOD diagnoses varied across clinics, as did LICSW registry use.  Clinic 1 had 297 patients with recent AOD diagnoses and LICSW registry documentation for 87 patients (29%).  Clinic 2 had1,053 patients and LICSW registry documentation for 15 patients (1.4%).  Clinic 3 had 220 patients and LICSW registry documentation for 113 patients (51%).  Of note, Clinic 2 implemented workflow changes in March 2015 emphasizing warm handoffs to the LICSWs.  Registry use did not capture warm handoffs, which may explain low registry documentation at this clinic.  Qualitative findings show LICSWs were initially uncomfortable with “cold calling” registry patients but found that patients were receptive to the calls and often voiced appreciation.  LICSWs became skilled in managing AOD and routinely assisted PC providers in accessing information on prescribing medications for alcohol use disorders.  LICSWs were motivated in meeting patients where they were at and providing hope and support for them. 

Conclusion and Implications: Registry use varied greatly across site, ranging from 1.4% to 51%.  Despite varied use, two hours of training and weekly supervision meetings increased LICSW skills and engagement in managing AODs.  Leaders in the integrated system decided to expand the LICSW registries to other clinics.  The next phase of research will evaluate LICSW care documented outside the registry.  Although more research on whether the pilot increased patient engagement in AOD care is needed, preliminary findings show the feasibility of LICSWs using populated-based EHR registries and MI skills to improve access to care for patients with AOD diagnoses.