Abstract
BackgroundAlarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use.MethodsThis study uses a phased cluster randomized mixed method design to test nurse-led implementation of an SBIRT toolkit on one medical-surgical unit at 14 acute care hospitals (critical access, community and academic health centers). Medical surgical units will be randomly assigned to implement the SBIRT toolkit (engagement and communication, assessment, planning, training, and evaluation tools) or a wait-list usual care control group that begins implementation 6 months later. Primary endpoints are documentation of SBIRT delivery in randomly selected electronic medical records at baseline, 6 months and 12 months after group 1 implementation (61 records per unit per time period, N = 2562). Two surveys will be administered to unit nurses: smoking cessation activities will be assessed at baseline and SBIRT use will be assessed on randomly-selected days after implementation. In addition, site coordinators will complete a baseline capacity assessment, an implementation fidelity survey post-implementation, and a structured interview at the end of the study. Multilevel mixed-effects effects logistic and linear models will be used to analyze use of SBIRT and cost outcomes.DiscussionThis study will guide subsequent SBIRT implementation, dissemination, and spread across rural, community and urban healthcare systems throughout the state and beyond. The long-term objective is to activate clinicians to recognize, intervene and refer people with risky substance use to improve health and decrease substance use disorders.Trial registration ClinicalTrials.gov NCT03560076
Highlights
Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use
According to the World Health Organization, mental health and substance use disorders will surpass all physical diseases as a major cause of disability worldwide by 2020 [1]
The purpose of this study is to examine SBIRT implementation methods across rural, community and urban acute hospital settings
Summary
Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Alcohol use is linked to significant economic and health costs on a global scale [3]. It is often a contributing factor in homicides, suicides, crimes (violent, including homicide, and non-violent), motor vehicle collisions (non-fatal and fatal), and unintentional injuries to the drinker and others in his/her environment [4]. Heavy drinking can lead to a pattern of abuse and/or dependence that is often associated with other harmful behaviors such as cigarette smoking, unsafe sex, and illicit drug use [5]. Even lower levels of drinking, while potentially asymptomatic, are associated with health risks [6]
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