Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 144-150 (doi:10.1542/peds.2008-2979)

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ARTICLE

Primary Care Follow-up Plans for Adolescents With Substance Use Problems

Areej Hassan, MD, MPH^a, Sion Kim Harris, PhD^a,b, Lon Sherritt, MPH^b,c, Shari Van Hook, MPH^b,c, Traci Brooks, MD^a,d, Peggy Carey, MD^e,f, Robert Kossack, MD^g, John Kulig, MD, MPH^h and John R. Knight, MD^b,c

^a Division of Adolescent Medicine
^b Center for Adolescent Substance Abuse Research
^c Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
^d Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts
^e Department of Family Medicine, University of Vermont College of Medicine, Burlington, Vermont
^f Family Medicine, Milton Family Practice, Milton, Vermont
^g Pediatrics, Fallon Clinic, Worcester, Massachusetts
^h Adolescent Clinic, Tufts Medical Center's Floating Hospital for Children, Boston, Massachusetts

OBJECTIVE: Primary care visits provide an opportunity to screen adolescents for substance use and offer early intervention, but little is known about follow-up plans. The objective of this study was to determine recommendations by PCPs and assess the relationship between their diagnostic impressions of substance use severity and plans for intervention.

METHODS: Data were collected through a prospective observational study conducted at 7 primary care practices in New England. Patients aged 12 to 18 years completed an interview, which included sociodemographic characteristics and the CRAFFT substance abuse screen. PCPs received screen results, noted their diagnostic impression of participants' substance use severity, and recorded follow-up plans. Follow-up plans other than "periodic screening" alone were defined as "active intervention." We examined the relationship of provider impressions with follow-up recommendations by using the ² test.

RESULTS: For 2034 adolescents, PCPs recommended no plan for 369 patients, periodic screening for 1557 patients, a return visit for 98 patients, and referral to counseling for 44 patients. PCPs' diagnostic impressions identified 97 (4.8%) patients with problem use and 19 (0.01%) patients with abuse or dependence. Recommendations for active intervention were more likely with patients' higher severity of use. However, 1 in 5 patients thought to have problem use did not receive a recommendation for an active intervention. Parent notification was planned for only 13 patients.

CONCLUSIONS: When concerned about substance use, PCPs recommend a return visit to their office more than twice as often as referral to counseling, and rarely planned to engage parents. PCPs need enhanced training and strategies for delivery of office-based interventions.

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Key Words: adolescence • substance abuse • treatment recommendations

Abbreviations: PCP—primary care provider • HMO—health maintenance organization • RA—research assistant • aOR—adjusted odds ratio • CI—confidence interval

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Accepted Jan 5, 2009.

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