Table 2 Screening program elements and implementation strategy utilized by study clinics
Element | Description |
|---|---|
Screening Program Elements | |
 EHR | Centricity EHR |
Custom software to collect screening on tablets and transfer into EHR | |
 Visits eligible for screening | Annual adult preventive care appointments |
 Screening tools | Tobacco, alcohol, prescription medication, and other substance (TAPS) Toola |
   TAPS-1 for screening (any past year use) | |
   TAPS-2 for brief assessment (current use, risk level) | |
Established cutoffs categorized level of risk: 0 = low risk/no current use; 1 = moderate risk; 2+  = high risk | |
 Mode of screening | Self-administered on a tablet while in waiting room |
Completed by medical assistant for patients needing assistance | |
 CDSS: clinical reminder | Alert in EHR indicating that a patient is due for screening (based on age, visit type and not being screened in the past 12 months) |
 CDSS: counseling and referrals | Template built into the EHR provided guidance for conducting and documenting a brief intervention |
Accessed in the TAPS results page; tab with fillable fields to document patient responses | |
Designed to be delivered in ~ 5 min | |
Guided providers through the four major components of a brief negotiated interview: raising the subject, providing feedback, enhancing motivation, and formulating a planb | |
Order set for patient education materials and referral for treatment or social work assessment | |
Implementation strategy | |
 Clinical champions | Each clinic had one ‘clinical champion’ PCP |
Worked with the research team and led implementation at their clinic | |
Met approximately monthly with the practice facilitator | |
Assisted with training of clinic staff | |
 Practice facilitation | One staff member from the FQHC’s quality improvement unit for reporting, monitoring and ongoing education |
Assisted by one trained research assistant who worked across all clinics | |
 Training | Conducted by FQHC substance use clinical leader (TG) |
Offered during established meeting times to facilitate attendance | |
PCPs: One group training session on screening, brief intervention, and use of the CDSS (30–45 min) | |
Medical assistants and front desk staff: one brief training focused on the screening workflow | |
PCPs and medical assistants who were unable to attend group training had the option of receiving individual training | |