Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians

Abstract

BackgroundScreening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of patient and health care provider resources designed to enhance the capacity of health care providers to use SBIRT and improve patient engagement with health care.Methods/DesignA nonrandomized, two-group, pre-post, quasi-experimental intervention design was used, with baseline, 6-, and 12-month follow-ups. Low income patients using alcohol and other drugs and who sought care in family medicine and emergency medicine settings in Edmonton, Canada, along with physicians providing care in these settings, were recruited. Patients and physicians were allocated to the intervention or control condition by geographic location of care. Intervention patients received a health care navigation booklet developed by inner city community members and also had access to an experienced community member for consultation on health service navigation. Intervention physicians had access to online educational modules, accompanying presentations, point of care resources, addiction medicine champions, and orientations to the inner city. Resource development was informed by a literature review, needs assessment, and iterative consultation with an advisory board and other content experts. Participants completed baseline and follow-up questionnaires (6 months for patients, 6 and 12 months for physicians) and administrative health service data were also retrieved for consenting patients. Control participants were provided access to all resources after follow-up data collection was completed. The primary outcome measure was patient satisfaction with care; secondary outcome measures included alcohol and drug use, health care and addiction treatment use, uptake of SBIRT strategies, and physician attitudes about addiction.DiscussionEffective knowledge translation requires careful consideration of the intended knowledge recipient’s context and needs. Knowledge translation in disadvantaged settings may be optimized by using a community-based participatory approach to resource development that takes into account relevant patient engagement issues.Trial registrationNorthern Alberta Clinical Trials and Research Centre #30094

Interventions to Reduce Stigma Related to People who Use Drugs: Systematic Review

“…Such interventions rely on evidence that stigma plays a role in adherence to treatment for both drug dependence or primary healthcare. Engaging people who use drugs in care may improve patient satisfaction with treatment and the quality of interventions (Salvalaggio et al, 2013).…”

“…Educational intervention, lecture about the AA, and technical visit Improved attitudes towards AA; greater belief in its effectiveness Salvalaggio et al (2013) 300 doctors…”

“…Educational strategies have positive effects on attitudes and behavioral intentions; yet, contact is the strategy for change considered more effective among adults in the general population (Thornicroft et al, 2015) and was underused by the studies evaluated in this review. Among the studies that used contact, they did not adopt it as a central component in the proposed interventions (Ballon & Skinner, 2008;Chappel & Veach, 1987;Crapanzano et al, 2014;Gerace et al, 1995;Heiligman & Nagoshi, 1994;Meltzer et al, 2013;Ramirez-Cacho et al, 2007;Salvalaggio et al, 2013;Silins et al, 2007).…”

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders

“…The low usage rate of substance abuse treatment emphasizes the need for incorporating screening of substance use, brief intervention and referral to treatment (SBIRT) programs into primary care to increase early detection and recognition of substance use status, along with timely interventions for substance-related problems (Moyer, 2013 ; Pilowsky & Wu, 2013 ; Salvalaggio et al 2013 ). The Affordable Care Act (ACA) has expanded access to mental and substance abuse services (i.e.…”

Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center

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