Screening, Brief Intervention, And Referral To Treatment Implementation Research Articles

Screening, brief intervention, and referral to treatment for drug- and alcohol-related health problems in emergency departments (EDs): review of outcomes, implementations, and costs

We conducted a literature review of screening, brief intervention, and referral to treatment (SBIRT) in emergency-department (ED) settings to evaluate intervention designs, outcomes, cost-savings, and implementation. Publications selected were primary or secondary research of SBIRT in ED settings for alcohol or drug use. Publications were separated into three categories: outcomes, costs, and implementation. Outcome literature excluded secondary research, focusing on primary analyses of SBIRT in ED settings that targeted drug and alcohol use. Twenty-six articles were found and grouped into interventions for alcohol or drugs. Some studies appeared in both groups. Of the 25 alcohol studies, 22 reported significant treatment effects. Of the 10 drug studies, eight reported significant treatment effects. Most studies reported outcome measures as change in alcohol or drug use; others identified treatment attendance or assessment scores as outcome variables. With regard to cost, nine publications outlined cost-savings, including reduced recurrent substance-related ED visits and reduced cost per patient. With regard to implementation, 22 publications discussed SBIRT implementation in EDs. Research suggests that physicians and mid-level providers can efficiently conduct SBIRT and address substance use disorders among ED patients. Although SBIRT has been successfully integrated into many busy EDs, it is a challenge requiring ongoing commitment, planning, and support from ED staff. Despite barriers to SBIRT implementation, EDs that have implemented SBIRT show cost savings and improved ability to diagnose and treat alcohol- and drug-related problems. Future research should explore the effect of SBIRT in EDs for drug-related problems as well as its long-term sustained implementation.

Assessing the impact of screening, brief intervention, and referral to treatment implementation on attitudes toward and moralization about alcohol, tobacco, and other drug use

Screening, brief intervention, and referral to treatment (SBIRT) dissemination has been presented as a way to change medical professionals’ attitudes toward adopting prevention practices for alcohol and other drug use. We evaluated the impact of SBIRT dissemination on attitudes related to preventive practices for alcohol consumption and on the moralization of alcohol and other drug use by primary care professionals (N = 123) in two Brazilian cities. Eighty-two participants received SBIRT training (intervention group), while 41 received no SBIRT training (control group). At baseline and three-month follow-up, both groups completed scales of beliefs and attitudes regarding SBIRT implementation and another scale about the moralization of tobacco, alcohol, marijuana, cocaine, and crack use. The intervention group showed an increase in the perception of obstacles to screening implementation at follow-up assessment (p < 0.05). Regarding moralization, the intervention group had lower moralization for crack consumption than controls at follow-up (p < 0.05). The other measures showed no significant differences. According to these results, SBIRT training and three months of practice supervision were not sufficient to promote changes in primary care professionals’ attitudes toward drug and alcohol screening or to reduce substance use moralization. These findings are relevant to research related to SBIRT dissemination, since merely learning SBIRT techniques without attitudinal changes and moralization reduction compromises the quality and effectiveness of those practices with regard to alcohol and other drug use.

Factors associated with effective implementation of screening, brief intervention, and referral to treatment in the emergency department

Evidence-based screening, brief intervention, and referral to treatment (SBIRT) programs focusing on drug and alcohol use have successfully been implemented in a variety of general medical settings. Such programs require adaptations to function effectively in a high-volume hospital emergency department (ED) setting. We describe implementation and training procedures used in the six-site National Institute on Drug Abuse-Clinical Trials Network (NIDA-CTN) Screening, Motivational Assessment, Referral and Treatment (SMART-ED) trial and present lessons learned from the implementation of the study. The discussion is organized around issues of site selection, staff selection, research assistant and interventionist training, site preparation, and data collection. Several implementation components were particularly important in the SMART-ED trial: 1) Site selection—department and ED staff buy-in was central to decisions on which sites were chosen to participate. 2) Staff selection—interventionists/RAs needed to possess both the empathy necessary to deliver a motivational-interviewing intervention and the research knowledge necessary for protocol adherence. 3) Research assistant and interventionist training and ongoing coaching—in-person and webinar trainings ensured that research staff understood and were able to follow protocol procedures and were certified to deliver the intervention and study procedures that required it. Ongoing coaching based on reviews of the intervention recordings and feedback on compliance with study procedures is successfully preventing drift. 4) Site preparation—prior to beginning the main trial, each site had real-world practice conducting study procedures through standardized patient visits. 5) Data collection—screening data is collected using direct entry into tablet computers to facilitate rapid screening and mobility in the ED setting. There are unique factors associated with effective implementation of SBIRT delivered in the ED. Some of the procedures used in this clinical trial may be useful in the successful implementation of clinical SBIRT programs in EDs.

A Clarion Call for Nurse‐Led SBIRT Across the Continuum of Care

This commentary discusses the impact of the study by Broyles and colleagues (2012) that reported on hospitalized patients' acceptability of nurse-delivered screening, brief intervention, and referral to treatment (SBIRT). This cross-sectional survey study assessed patient acceptability for and comfort with nurse-delivered SBIRT. The majority (95%) of inpatients found it acceptable for the nurse to ask about and/or discuss alcohol use during their hospitalization. This is a significant finding, as hospitals in the United States consider whether and how to implement The Joint Commission's performance measures related to SBIRT for hospitalized patients. The findings related to subgroups of patients who are more accepting of SBIRT and those who expressed some degree of discomfort highlight the importance for individualized patient-centered approaches. This study raises several important implications for nurse-delivered SBIRT. First, intensive efforts must be directed to enhancing the knowledge and competence of healthcare providers in general, and the current and future nursing workforce in particular, related to alcohol use and evidence-based care for patients who are drinking alcohol above recommended limits. Second, registered nurses, working to the full extent of their education and licensure are in key roles as members of the interdisciplinary team to provide cost-effective care at the bedside and across the continuum of care. Nurse-led SBIRT implementation models could help bridge the curricular gap and promote widespread and sustained integration of SBIRT as standard nursing care across all specialties and practice settings.

P.3.a.040 Reasons for admission of psychotic patients to psychiatric emergency services

The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery.Data for the study (N = 67 137) were derived from weekly reports extracted directly from one hospital’s electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods.Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14 166 = 3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods.When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability.

Screening, Brief Intervention and Referral to Treatment (SBIRT) in a Polish Emergency Room: Challenges in Cultural Translation of SBIRT

A randomized clinical controlled trial of screening, brief intervention and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers, using nurse interventionists, was undertaken in an emergency room (ER) in Sosnowiec, Poland, the first level-one trauma center in that country. This study was the first outside of the U.S. to test protocols developed in a 14-site collaborative SBIRT study. Because Poland has both a pattern of heavy drinking and a highly accessible specialized alcohol treatment system, it offered a key setting for cultural translation of SBIRT to the international context of a new and emerging health care system. It also offered the opportunity to test the effectiveness of SBIRT with both at-risk and dependent drinkers, and to test the feasibility of using ER nursing staff to provide the brief intervention, serving as a potential model for ongoing implementation of SBIRT in ER settings. Findings suggest that the U.S.-based SBIRT protocols can be successfully translated to other cultures, and that nurses can be successfully trained to provide brief intervention for problem drinking in the ER setting.