Project Summary
The US healthcare delivery system suffers from intractable problems that increasingly prevent it from
identifying and treating people suffering from SUDs. Primary care clinicians, the front line of our health care
delivery system, have neither adequate tools nor incentives to evaluate SUDs and co-occurring mental health
disorders. The result is chronic under-diagnosis and under-treatment, in addition to the associated adverse
personal and societal impacts. These shortcomings disproportionately affect individuals from underserved
populations who already have poor access to health care resources.
We propose to develop and test a new Primary Care-SUD-Intake System (P-SUD-IS) that is intended
to address the problem of under-diagnosis by changing primary care clinician behavior and motivating clients
with previously undiagnosed SUDs to seek help. The P-SUD-IS will be a HIPAA-compliant, user-friendly,
automated, and cloud-based system, and, if successful, will reduce the time needed for primary care clinicians
to complete and bill for a biopsychosocial assessment. The P-SUD-IS will assess and record family SUD
history, personal SUD history, educational history, occupational history, social history, current social supports,
and willingness to participate in treatment. Diagnosis and a mental status exam will be conducted using
TeleSage’s existing validated DSM-5 self-report diagnostic system (SAGE), which will be integrated into the
new P-SUD-IS. Responses to all questions will be used to provide clinicians with detailed electronic reports
that can be entered into the client’s EHR. This system is in no way intended to replace the clinician. As a
decision-support tool, the P-SUD-IS is intended to help clinicians without specialized training in behavioral
health and SUDs use all available resources to complete a biopsychosocial assessment.
This study will assess whether underserved primary care clients might be willing and able to complete
the P-SUD-IS. Questions will be written at a 5th grade reading level and read aloud using a native text-to-
speech application. The client will receive a highly customized electronic report with educational & self-help
information as well as links to relevant on-line referral systems.
The P-SUD Intake System will generate a report containing actionable information that will make it easier for
primary care clinicians to determine if a referral is warranted, and for them to provide the referral
documentation that will be most helpful. The new strategy needs to fit within the normal workflow of primary
care clinics so as not to cause disruptions. Our goal is for the clinician to be able to look at the report for 2-3
minutes, ask the client specific questions informed by the report, discuss options with the client, finalize the
treatment plan, write orders, and bill a sufficient amount for a biopsychosocial assessment to make the whole
process economically feasible. By making primary care SUD assessments cost effective and feasible, the P-
SUD-IS will have a large impact on the underserved and undiagnosed.
