Implementing the DAST-10 Screening Tool in a Primary Care Practice

Abstract

Purpose: This quality improvement initiative aimed to engender use of the Drug AbuseScreening Test 10 (DAST-10) in a single practice within a Federally Qualified Health Center (FQHC) in preparation for the instrument to be incorporated into all its primary care practices. Background: Illicit drug use and/or illicit use of prescription drugs is endemic in the United States (US). In Pima County, deaths from overdoses reached the highest level in 2019, with 32.3 deaths per 100,000, a 17.8% increase over the previous year and higher than the national total of 21.6 per 100,000. Accidental death by overdose accounted for 91% of cases in 2019 in Pima County. Regular screening for substance abuse at the primary care level is supported in the literature and recommended by the United States Preventive Services Task Force (USPSTF). The DAST-10 is an easily administered brief screening for drug use that can be implemented in primary care practice to identify patients at risk of developing substance use disorder (SUD) or who currently have SUD (Patnode et al., 2020). Methods: Participants were convenience sample of two physicians, four family nurse practitioners, and five medical assistants at a community health center primary care clinic. A pretest/posttest design gauged change in support for the DAST-10. An education session was conducted at an in-person meeting, followed by email delivery of the pretest questionnaire. Two Plan-Do-Study-Act (PDSA) cycles of two weeks each were conducted, during which total number of screenings and scores were made available to the participants. The end of the intervention was an identical posttest questionnaire. Results: Pretest and posttest questionnaires did not show significant improvement in participants’ opinions and attitudes regarding the DAST-10. On a Likert scale of 1-5, ordered 10 from left to right, aggregated results showed a mean score of 4.29 pre-intervention and 4.11 post- intervention. The reception was generally positive toward the screen from pre- to post- intervention. Conclusions: The DAST-10 is now used at the clinic site. Patients scoring 3-10 are met by the Behavioral Health Consultant (BHC) after PCP appointments for further discussion and/or referral to treatment. Removal of barriers to use warrants further study.