Implementing Computerized Substance Use and Depression Screening and Evidence-based Treatments in an HIV Primary Care Population

Time frame

12 months pre-implementation period to the end of the implementation period, up to 21 months

Measure

COUNT_OF_PARTICIPANTS · Participants

Reporting status

POSTED

Rate of screening using usual care methods (pre-implementation) compared with rate of screening using computerized methods, based on electronic health record (EHR) data.

Time frame

Percent treated by 6 months after newly identified substance use

Measure

COUNT_OF_PARTICIPANTS · Participants

Reporting status

POSTED

Initiation of substance use, anxiety and depression treatment services, based on EHR data

Time frame

Percent treated by 6 months after newly identified mental health problem

Measure

NUMBER · participants

Reporting status

POSTED

Initiation of substance use, anxiety and depression treatment services, based on EHR data

Time frame

First post intervention screen (1 month) to second post intervention screen (21 months)

Measure

MEAN · scores on a scale

Reporting status

POSTED

Unadjusted mean change of screening scores for Tobacco, alcohol, and cannabis use from first post intervention screen to second post intervention screen using the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool. The score ranges from zero - 3 for each substance, zero indicating no use and 2 or higher indicating high-risk, for each substance. 0 = No Use in Past 3 Months, 1 = Problem Use, and 2+ = Higher Risk.

Population: Of 2,865 people with HIV screened across all three clinics post-intervention, 403 screened positive at first screen AND completed a follow-up screen.

Time frame

First post intervention screen (1 month) to second post intervention screen (21 months)

Measure

MEAN · scores on a scale

Reporting status

POSTED

Unadjusted mean change of screening scores for depression and anxiety from first post intervention screen to second post intervention screen. The PHQ-9 assesses degree of depression severity. The score ranges from zero - 27 with higher scores indicate higher depression. GAD-2 assesses degree of anxiety severity. The score ranges from zero - 6 with higher scores indicate higher anxiety.

Population: Of 2,865 people with HIV screened across all three clinics post-intervention, 403 screened positive at first screen AND completed a follow-up screen.

Time frame

change between 24 months prior to clinic-specific implementation date and end of implementation period, up to 21 months

Measure

COUNT_OF_PARTICIPANTS · Participants

Reporting status

POSTED

Change in participants with well controlled HIV RNA by 12 months after newly identified substance use problem

Time frame

change between 24 months prior to clinic-specific implementation date and end of implementation period, up to 21 months

Measure

COUNT_OF_PARTICIPANTS · Participants

Reporting status

POSTED

Change in participants with well controlled HIV RNA by 12 months after newly identified mental health problem

Intervention was implemented sequentially at three clinics, starting in Oakland on 10/30/2018, next in Sacramento on 2/1/2019 and finally on 6/1/2019 in San Francisco, and continued until 7/17/2020 in all 3 clinics. In each clinic an observation period of 12 to 24 months prior to implementation was designated as pre-intervention period, depending on the analyses. Analyses were done at the participant level, not at the clinic level, and compared pre- and post-implementation periods.