Developing and Evaluating an Integrated Substance-Abuse Curriculum for Implementation in a Primary Care Setting

Abstract

Equipped with appropriate skills, the primary care provider can play a significant role in the detection, treatment, and prevention of potentially dangerous substance use. A program with specific goals to develop, test, and disseminate a new integrated substance-use curriculum has been designed especially for health care providers in the primary care setting. Three key, integrated educational methods provide the core curriculum material. The first method employs the use of video trigger tapes of interviews with substance users and nonusers of various ages. The tapes are designed to impart direct didactic knowledge about substance use, including epidemiology, developmental stages of use, clinical presentations, and comorbidities. The effectiveness of the tapes in enhancing knowledge in these areas is assessed through standardized question/answer tests administered before and after tape sessions. Perhaps most important, the tapes are designed to evoke explicit attitudes from the primary care providers about substance abuse. Review of the extent and content of the discussions following the tapes as well as scales measuring attitudes given both before and after viewing serve in evaluation. The second teaching method employed is the use of a skills checklist, part of which is illustrated in the videotaped interviews. The goals of the five subsections of the skills checklist are to: 1) create the appropriate setting for discussions substance use; 2) ensure confidentiality to the patient; 3) bring up the topic of drug and alcohol use; 4) assess risk/use; and 5) negotiate for treatment and follow-up. The effectiveness of the skills checklist is assessed by the third instructional method. This method fosters skill-building through the use of role play in clinical application exercises utilizing participants in the curriculum as well as trained, simulated patients. Assessment is provided quantitatively by direct scoring of the skills checklist and qualitatively through personal review and group discussion of a video-taped encounter. The research agenda of the project focuses on identifying specific measures to evaluate the effectiveness of these three teaching methods. With careful integration of teaching methods and evaluation tools, a focused approach to substance abuse education can be effectively administered and evaluated in the primary care setting.