C4-3: Implementation of a Screening Brief Intervention and Referral to Treatment (SBIRT) Protocol in Primary Care

Abstract

;Background/Aims: Substance abuse in the United States is a serious public health concern; however, routine screening is inconsistent in primary care. In partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), Kaiser Permanente Colorado (KPCO) implemented the Screening Brief Intervention and Referral to Treatment (SBIRT) protocol in one primary care clinic over a 3-month period in order to determine staff perceptions, barriers, and solutions for wide-scale implementation. Methods: Based on prior feasibility studies, clinic staff were engaged in order to anticipate barriers and solutions to improve implementation success. A quantitative survey of team functioning and clinic priority for implementing SBIRT was also conducted prior to implementation. Screening was conducted by front desk staff of all adult Health Maintenance Visits (ages 19-64 years) using a 3-question paper questionnaire, followed by Brief Intervention delivered by the behavioral medicine specialist (BMS) in the case of positive screening result. This workflow was determined by the clinic despite prior feasibility results indicating optimal workflow consisting of screening by Medical Assistants and Nurses during the rooming process due to multiple competing demands from the organization during the implementation period. Results: A total of 1097 eligible patients were seen during the 3-month implementation, 321 (29%) were screened for alcohol use, and 15 (5%) required additional Brief Intervention with the BMS. Positive results of implementation included improved awareness by physicians of alcohol use, better communication among members of the care team, and integration of the BMS as a resource for the care team. Barriers included patient resistance, competing demands on the clinic, and lack of information on screening recorded in the medical record. Post-study debriefing with primary care and BMS staff led to a commitment by clinic leadership and staff to revise workflow and explore regional implementation strategies. Solutions include additional training regarding clinical utility of screening and options for normalizing screening for patients and solutions for recording screening in the EMR. Conclusions: Through continued use of SBIRT, this clinic will also demonstrate the value of screening for drug and