Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes

Muench, John; Jarvis, Kelly; Vandersloot, Denna; Hayes, Meg; Nash, Whitney; Hardman, J. A.; Grover, Peter; Winkle, Jim

doi:10.1080/07347324.2015.1018775

Cited by 16 publications

(25 citation statements)

References 30 publications

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“…The practice champion does not necessarily need to be the medical director of the practice, but should be someone who is respected by their coworkers. Several studies have cited the need for a champion to encourage staff buy-in and engagement and to identify and manage ongoing barriers to program success [ 20 , 34 ]. This was consistent with our findings where a program leader who could act as cheerleader, door opener, and bridge between all team members was key to a successfully integrated program.…”

Section: Screening In Primary Care Projectmentioning

confidence: 99%

“…Physicians often mention their lack of time as a major barrier to SBIRT [ 14 , 19 ]. Involving an interprofessional team can mitigate the physician’s role in favor of shared responsibility among all participants in the SBIRT continuum of care [ 18 , 20 , 28 ]. These interprofessional team members need to be involved from the planning stage.…”

Section: Screening In Primary Care Projectmentioning

confidence: 99%

“…Bernstein et al describe lessons following a well-funded emergency department (ED) program, including external funding for start-up, local ED staff champions, sustainability planning from the beginning, and creation and maintenance of a robust referral network [ 15 ]. Singh et al interviewed administrators and evaluators from six SAMHSA SBIRT grantee programs and found sustainability after the grant funding ended was related to securing new funding, having champions, adapting and making system changes, and managing program staffing challenges [ 17 ].Muench and Holland performed focus groups of team members and physicians in Oregon and Pennsylvania, respectively, during state-funded alcohol SBIRT projects [ 19 , 20 ]. Both sets of researchers noted similar barriers, including time constraints, limited access to treatment, ongoing funding and reimbursement concerns, and limited knowledge and self-efficacy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

et al. 2017

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BackgroundScreening, Brief Intervention and Referral to Treatment (SBIRT) is a public health framework approach used to identify and deliver services to those at risk for substance-use disorders, depression, and other mental health conditions. Primary care is the first entry to the healthcare system for many patients, and SBIRT offers potential to identify these patients early and assist in their treatment. There is a need for pragmatic “best practices” for implementing SBIRT in primary care offices geared toward frontline providers and office staff.MethodsTen primary care practices were awarded small community grants to implement an SBIRT program in their location. Each practice chose the conditions for which they would screen, the screening tools, and how they would provide brief intervention and referral to treatment within their setting. An evaluation team communicated with each practice throughout the process, collecting quantitative and qualitative data regarding facilitators and barriers to SBIRT success. Using the editing method, the qualitative data were analyzed and key strategies for success are detailed for implementing SBIRT in primary care.ResultsThe SBIRT program practices included primary care offices, federally qualified health centers, school-based health centers, and a safety-net emergency department. Conditions screened for included alcohol abuse, drug abuse, depression, anxiety, child safety, and tobacco use. Across practices, 49,964 patients were eligible for screening and 36,394 pre-screens and 21,635 full screens were completed. From the qualitative data, eight best practices for primary care SBIRT are described: Have a practice champion; Utilize an interprofessional team; Define and communicate the details of each SBIRT step; Develop relationships with referral partners; Institute ongoing SBIRT training; Align SBIRT with the primary care office flow; Consider using a pre-screening instrument, when available; and Integrate SBIRT into the electronic health record.Conclusions and implicationsSBIRT is an effective tool that can empower primary care providers to identify and treat patients with substance use and mental health problems before costly symptoms emerge. Using the pragmatic best practices we describe, primary care providers may improve their ability to successfully create, implement, and sustain SBIRT in their practices.

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Section: Screening In Primary Care Projectmentioning

confidence: 99%

Section: Screening In Primary Care Projectmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

et al. 2017

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“…As other researchers have suggested, these might include the addition of a champion who can encourage HCPs to conduct a brief intervention to all patients who are drinking above guidelines and to problem solve barriers [74,82] as well as having ongoing training in alcohol screening and brief intervention. This might be particularly important in clinics with high staff turnover [82][83][84][85]. Both the champion and the training should emphasize the importance of making sure that sex and gender are taken into consideration when delivering brief alcohol intervention (e.g., addressing stigma and fear associated with reporting alcohol use during pregnancy and motherhood) [86][87][88][89].…”

Section: Discussionmentioning

confidence: 99%

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial

Minian

Ivanova

Voci

et al. 2020

IJERPH

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Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)—prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines—were moderated by patients’ sex. Patients (n = 5702) enrolled in a smoking cessation program at primary care sites across Ontario, Canada, were randomized to either the intervention (CDSS) or control arm (no CDSS). Logistic generalized estimating equations models were fit for the primary and secondary outcome (HCP offer of resource and patient acceptance of resource, respectively). Previously reported results showed no difference between treatment arms in HCP offers of an educational alcohol resource to eligible patients, but there was increased acceptance of the alcohol resource among patients in the intervention arm. The results of this study showed that these CDSS intervention effects were not moderated by sex, and this can help inform the development of a scalable strategy to overcome gender disparities in alcohol intervention seen in other studies.

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“…Barriers to delivering SBIRT in primary care may account for some of the negative outcomes regarding its efficacy. Barriers to screening and brief intervention for SUD include time constraints [ 14 ], fear of alienating the patients [ 15 ], and the challenge of working with patients with SUD and pain [ 16 ]. The barriers to referring patients for additional evaluation or specialty treatment include patient resistance [ 17 , 18 ], the stigma attached to treatment [ 19 ], and limited treatment resources [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability

2018

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BackgroundIn 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients.ObjectiveThe objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions.MethodsA total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items.ResultsFor providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5).ConclusionsThe SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients.

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Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes

Cited by 16 publications

References 30 publications

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial

Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability

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