Strengths & limitations
The PACE trial occurred during normal primary care visits in an integrated healthcare system with a diverse patient population. We had a large sample size and a substantial number of respondents who completed screening both pre- and during early COVID. However, there were some study limitations. First, our screening process was tied to upcoming attendance at primary care visits. While uncoupling screenings from visits might have increased the pool of individuals invited to complete screening questionnaires, it could also reduce the screening completion rate because most members of the healthcare system have been accustomed to receiving screening questionnaires prior to upcoming appointments of all types through the patient portal system. Linking screenings to upcoming visits may increase motivation to complete questionnaires, since patients anticipate that providers may expect a response. Primary care visits are a key component of routine health care in most settings and having screenings tied to upcoming primary care visits could make our results more generalizable to a variety of healthcare settings.Our results were also based on self-report, which may result in underestimation of substance use. [