Table 2.
KTA Results
| KTA domain | Patient quotes | Primary care provider (PCP) quotes | Medical assistant (MA) quotes |
|---|---|---|---|
| Identifying the problem | |||
|
Current screening practices |
DNE | Implementation definitely varies widely from one provider to the next. | I feel like it should be brought up more… I only have the first encounter with the patient, after that it’s not mentioned. |
| Importance of substance use (SU) screening | I do think it could be important to talk about these risks…to help [patients] live longer. | It’s a top priority. | It’s very important. |
| Adapting to the local context | |||
| Universal or targeted | Everybody should be screened. | We ask other preventative health questions to everybody, so I think SU disorder should be the same. | I do not think you can judge a book by its cover. You cannot always tell who needs to be asked. |
| Frequency | DNE | I always screen at least annually, or if there’s a compelling reason. | No less than every six months |
| Format | It might be easier for some to do it on a computer, or paper unless you have a connection with your doctor… which is not happening in this practice. | I think there are great advantages to self-administered. [Patients] have a little more time to reflect on their own rather than face-to-face where it can be a little more tempting not to share. | If you are filling out a piece of paper, you do not feel judged. |
| Assessing barriers | |||
| Patient/provider relationship | [To share SU] you have to know that your provider really does care for you and is not just taking care of you because it’s their job. | I would think that…as we see them, and start to develop rapport, that the percent starts to increase in terms of the number of patients we are identifying that do have SU issues. | It takes them longer to trust us before the provider; they have way more respect for the provider. |
| Comfort/preparedness discussing and treating SU | SU counselors are trained to look for SU. A medical doctor is trained to look for problems with the body. Sometimes they go together. Sometimes they do not. | I’m prepared, but yes, I could be better prepared…I’m very comfortable as long as I’m familiar with the patient. | DNE |
| Consequences of disclosing SU | I went to the ER with a broken leg and because I said something about SU I got no pain medication. | Somebody might decide not to use any kind of pain med for their broken leg… They’re afraid that’s going to happen, so they do not disclose. | If they are already on some type of pain med and they fess up to [SU], then they are going to think, “oh great, I’m gonna be cut off”. |
| Privacy | The information really does not stay private… that information flies all over. | The feedback I get from patients is they felt that their privacy was being invaded… They were not sure who that information would be going to. | They do not want to government to know. That’s exactly what they say. “It’s none of the government’s business.” |
| Lack of time | Unless the person is ready to say they need help… there’s just no way a doctor can do a complete study of you in a 15-minute period. | Time. That could be probably everyone’s answer. | We have no time. We’re trying to get through our part so fast that we are not cutting into the provider’s time. |
DNE Data did not emerge in substantive way on this topic