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Merchant RC, Baird JR, Liu T. Short-term Efficacy of a Brief Intervention to Reduce Drug Misuse and Increase Drug Treatment Utilization Among Adult Emergency Department Patients. Acad Emerg Med 2015; 22:1172-80. [PMID: 26375468 DOI: 10.1111/acem.12767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although brief interventions (BIs) have shown some success for smoking cessation and alcohol misuse, it is not known if they can be applied in the emergency department (ED) to drug use and misuse. The objectives of this investigation were to assess the 3-month efficacy of a BI to reduce drug use and misuse, increase drug treatment services utilization among adult ED patients, and identify subgroups more likely to benefit from the BI. METHODS This randomized, controlled trial enrolled 18- to 64-year-old English- or Spanish-speaking patients from two urban, academic EDs whose responses to the Alcohol, Smoking, and Substance Involvement Screening Test indicated a need for a brief or intensive intervention. Treatment participants received a tailored BI, while control participants only completed the study questionnaires. At the 3-month follow-up, each participant's past 3-month drug use and misuse and treatment utilization were compared to his or her baseline enrollment data. Regression modeling was used to identify subgroups of patients (per demographic and clinical factors) more likely to stop or reduce their drug use or misuse or engage in drug treatment by the 3-month follow-up assessment. RESULTS Of the 1,030 participants, the median age was 30 years (interquartile range = 24 to 42 years), and 46% were female; 57% were white/non-Hispanic, 24.9% were black/non-Hispanic, and 15% were Hispanic. The most commonly misused drugs were marijuana, prescription opioids, cocaine/crack, and benzodiazepines. Although at follow-up the proportions of participants reporting any past 3-month drug misuse had decreased in both study arms (control 84% vs. treatment 78%), the decreases were similar between the two study arms (Δ-6.3%; 95% confidence interval [CI] = -13.0% to 0.0). In addition, at follow-up there were no differences between study arms in those who were currently receiving drug treatment (Δ1.8; 95% CI = -3.5 to 6.8), who had received treatment during the past 3 months (Δ-2.0; 95% CI = -6.5 to 2.4), or who at least contacted a treatment program (Δ 1.7; 95% CI = -2.4 to 6.1). Those whose baseline screening indicated the need for a brief instead of a more intensive intervention, and those currently engaged in drug treatment at the 3-month follow-up, were generally more likely to stop or decrease their drug use/misuse. CONCLUSIONS The BI employed in this study did not reduce drug use and misuse or increase treatment utilization more than the control condition over a 3-month period. Future research should help determine what role, if any, BIs should play in affecting drug use and misuse among ED patients.
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Affiliation(s)
- Roland C. Merchant
- Department of Emergency Medicine; Alpert Medical School; School of Public Health; Brown University; Providence RI
- Department of Epidemiology; School of Public Health; Brown University; Providence RI
| | - Janette R. Baird
- Department of Emergency Medicine; Alpert Medical School; School of Public Health; Brown University; Providence RI
| | - Tao Liu
- Department of Biostatistics; Center for Statistical Sciences; School of Public Health; Brown University; Providence RI
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Cunningham RM, Chermack ST, Ehrlich PF, Carter PM, Booth BM, Blow FC, Barry KL, Walton MA. Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial. Pediatrics 2015; 136:e783-93. [PMID: 26347440 PMCID: PMC4586730 DOI: 10.1542/peds.2015-1260] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. METHODS Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program. RESULTS Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED. CONCLUSIONS A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation.
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Affiliation(s)
- Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Department of Health Behavior and Health Education and,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Peter F. Ehrlich
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Surgery, Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Brenda M. Booth
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Frederic C. Blow
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Kristen L. Barry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Maureen A. Walton
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
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Martino S, Zimbrean P, Forray A, Kaufman J, Desan P, Olmstead TA, Gueorguieva R, Howell H, McCaherty A, Yonkers KA. See One, Do One, Order One: a study protocol for cluster randomized controlled trial testing three strategies for implementing motivational interviewing on medical inpatient units. Implement Sci 2015; 10:138. [PMID: 26420671 PMCID: PMC4589113 DOI: 10.1186/s13012-015-0327-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and addiction recovery outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are accessible, have time for an intervention, and are often admitted for complications related to substance use that renders hospitalization a “teachable moment.” Methods/Design This randomized controlled trial will examine the effectiveness of three different strategies for integrating motivational interviewing (MI) into the practice of providers working within a general medical inpatient hospitalist service: (1) a continuing medical education workshop that provides background and “shows” providers how to conduct MI (See One); (2) an apprenticeship model involving workshop training plus live supervision of bedside practice (Do One); and (3) ordering MI from the psychiatry consultation-liaison (CL) service after learning about it in a workshop (Order One). Thirty providers (physicians, physician assistants, nurses) will be randomized to conditions and then assessed for their provision of MI to 40 study-eligible inpatients. The primary aims of the study are to assess (1) the utilization of MI in each condition; (2) the integrity of MI when providers use it on the medical units; and (3) the relative costs and cost-effectiveness of the three different implementation strategies. Discussion If implementation of Do One and Order One is successful, the field will have two alternative strategies for supporting medical providers’ proficient use of brief behavioral interventions, such as MI, for medical inpatients who use substances problematically. Trial registration Clinical Trials.gov (NCT01825057)
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Affiliation(s)
- Steve Martino
- Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Paula Zimbrean
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Joy Kaufman
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Paul Desan
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Todd A Olmstead
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, 2300 Red River St., Stop E2700, Sid Richardson Hall, Unit 3, Austin, TX, 78712, USA. .,Seton/UT Clinical Research Institute, 1400 North IH 35, Austin, TX, 78701, USA.
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Medicine, 60 College Street, New Haven, CT, 06510, USA.
| | - Heather Howell
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Ashley McCaherty
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
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Park TW, Cheng DM, Lloyd-Travaglini CA, Bernstein J, Palfai T, Saitz R. Changes in health outcomes as a function of abstinence and reduction in illicit psychoactive drug use: a prospective study in primary care. Addiction 2015; 110:1476-83. [PMID: 26075702 PMCID: PMC4521992 DOI: 10.1111/add.13020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
AIMS To test (1) whether abstinence and reduction in illicit psychoactive drug use were associated with changes in health outcomes in primary care patients and (2) whether these associations varied by drug type. DESIGN Secondary analysis of data from a randomized controlled trial that tested a brief intervention for drug use in primary care patients (589 enrolled, 574 completed a 6-month assessment). Analyses were conducted overall and stratified by the most commonly self-identified main drugs (marijuana, cocaine and opioids). SETTING AND PARTICIPANTS Patients who screened positive for illicit drug use at an urban primary care clinic in Boston, Massachusetts, USA. MEASUREMENTS Differences in past-month main drug use at baseline and 6-month outcome were categorized as continued or increased use, decreased use without abstinence and abstinence. Primary outcomes were 6-month changes in drug use consequences [Short Inventory of Problems scores (range 0-45)], depressive symptoms and health-related quality of life (HRQol). FINDINGS Abstinence was associated with a greater decrease in adverse drug use consequences than continued or increased use among the full sample and cocaine and opioids subgroups (adjusted means, full sample: -8.11 versus -0.05, P < 0.001; cocaine: -13.33 versus +1.09, P < 0.001, opioids; -16.84 versus -2.10, P < 0.001). Differences were not significant between those who decreased use compared with those who continued or increased use. There were no significant associations between drug use and depressive symptoms or HRQol. Neither abstinence nor decreased use was associated significantly with consequences in the marijuana subgroup. CONCLUSIONS Among primary care patients in the United States who use illicit psychoactive drugs, abstinence but not reduction in use without abstinence appears to be associated with decreased adverse drug use consequences.
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Affiliation(s)
- Tae Woo Park
- Division of General Internal Medicine, Department of Medicine, Alpert Medical School and Rhode Island Hospital, Providence, RI
- Department of Psychiatry and Human Behavior; Alpert Medical School and Rhode Island Hospital, Providence, RI
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | | | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Tibor Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
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Hawk KF, Vaca FE, D’Onofrio G. Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2015; 88:235-45. [PMID: 26339206 PMCID: PMC4553643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The opioid overdose epidemic is a major threat to the public's health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose.
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Affiliation(s)
- Kathryn F. Hawk
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Federico E. Vaca
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
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Clemence AJ, Balkoski VI, Schaefer BM, Lee M, Bromley N, Maisonneuve IM, Hamilton CJ, Lukowitsky MR, Poston J, Hall S, Pieterse P, Antonikowski A, Glick SD. Multispecialty screening, brief intervention, and referral to treatment (SBIRT) training in an academic medical center: Resident training experience across specialties. Subst Abus 2015; 37:356-63. [DOI: 10.1080/08897077.2015.1082953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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208
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Clemence AJ, Balkoski VI, Lee M, Poston J, Schaefer BM, Maisonneuve IM, Bromley N, Lukowitsky M, Pieterse P, Antonikowski A, Hamilton CJ, Hall S, Glick SD. Residents' experience of screening, brief intervention, and referral to treatment (SBIRT) as a clinical tool following practical application: A mixed-methods study. Subst Abus 2015; 37:306-14. [DOI: 10.1080/08897077.2015.1064850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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209
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Implementing Effective Substance Abuse Treatments in General Medical Settings: Mapping the Research Terrain. J Subst Abuse Treat 2015; 60:110-8. [PMID: 26233697 DOI: 10.1016/j.jsat.2015.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022]
Abstract
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described.
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McNeely J, Strauss SM, Saitz R, Cleland CM, Palamar JJ, Rotrosen J, Gourevitch MN. A Brief Patient Self-administered Substance Use Screening Tool for Primary Care: Two-site Validation Study of the Substance Use Brief Screen (SUBS). Am J Med 2015; 128:784.e9-19. [PMID: 25770031 PMCID: PMC4475501 DOI: 10.1016/j.amjmed.2015.02.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/05/2015] [Accepted: 02/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Substance use screening is widely encouraged in health care settings, but the lack of a screening approach that fits easily into clinical workflows has restricted its broad implementation. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify unhealthy use of tobacco, alcohol, illicit drugs, and prescription drugs. We evaluated the validity and test-retest reliability of the SUBS in adult primary care patients. METHODS Adults aged 18-65 years were enrolled from urban safety net primary care clinics to self-administer the SUBS using touch-screen tablet computers for a test-retest reliability study (n = 54) and a 2-site validation study (n = 586). In the test-retest reliability study, the SUBS was administered twice within a 2-week period. In the validation study, the SUBS was compared with reference standard measures, including self-reported measures and oral fluid drug tests. We measured test-retest reliability and diagnostic accuracy of the SUBS for detection of unhealthy use and substance use disorder for tobacco, alcohol, and drugs (illicit and prescription drug misuse). RESULTS Test-retest reliability was good or excellent for each substance class. For detection of unhealthy use, the SUBS had sensitivity and specificity of 97.8% (95% confidence interval [CI], 93.7-99.5) and 95.7% (95% CI, 92.4-97.8), respectively, for tobacco; and 85.2% (95% CI, 79.3-89.9) and 77.0% (95% CI, 72.6-81.1) for alcohol. For unhealthy use of illicit or prescription drugs, sensitivity was 82.5% (95% CI, 75.7-88.0) and specificity 91.1% (95% CI, 87.9-93.6). With respect to identifying a substance use disorder, the SUBS had sensitivity and specificity of 100.0% (95% CI, 92.7-100.0) and 72.1% (95% CI, 67.1-76.8) for tobacco; 93.5% (95% CI, 85.5-97.9) and 64.6% (95% CI, 60.2-68.7) for alcohol; and 85.7% (95% CI, 77.2-92.0) and 82.0% (95% CI, 78.2-85.3) for drugs. Analyses of area under the receiver operating curve (AUC) indicated good discrimination (AUC 0.74-0.97) for all substance classes. Assistance in completing the SUBS was requested by 11% of participants. CONCLUSIONS The SUBS was feasible for self-administration and generated valid results in a diverse primary care patient population. The 4-item SUBS can be recommended for primary care settings that are seeking to implement substance use screening.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University (NYU) School of Medicine, New York; Department of Medicine, New York University (NYU) School of Medicine, New York.
| | | | - Richard Saitz
- Department of Community Health Sciences, School of Public Health and Clinical Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Mass
| | | | - Joseph J Palamar
- Department of Population Health, New York University (NYU) School of Medicine, New York
| | - John Rotrosen
- Department of Psychiatry, NYU School of Medicine, New York
| | - Marc N Gourevitch
- Department of Population Health, New York University (NYU) School of Medicine, New York; Department of Medicine, New York University (NYU) School of Medicine, New York
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Mitchell SG, Schwartz RP, Kirk AS, Dusek K, Oros M, Hosler C, Gryczynski J, Barbosa C, Dunlap L, Lounsbury D, O'Grady KE, Brown BS. SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers. J Subst Abuse Treat 2015; 60:81-90. [PMID: 26297321 DOI: 10.1016/j.jsat.2015.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/11/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. METHODS This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DISCUSSION The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laura Dunlap
- RTI International, Research Triangle Park, NC USA
| | | | - Kevin E O'Grady
- University of Maryland, College Park, Department of Psychology, College Park, MD USA
| | - Barry S Brown
- Friends Research Institute, Baltimore, MD USA; University of North Carolina at Wilmington, Wilmington, NC USA
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212
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Barbosa C, Cowell AJ, Landwehr J, Dowd W, Bray JW. Cost of Screening, Brief Intervention, and Referral to Treatment in Health Care Settings. J Subst Abuse Treat 2015; 60:54-61. [PMID: 26160162 DOI: 10.1016/j.jsat.2015.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/30/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
AIMS This study analyzed service unit and annual costs of substance abuse screening, brief intervention, and referral to treatment (SBIRT) programs implemented in emergency department (ED), inpatient, and outpatient medical settings in three U.S. states and one tribal organization. METHODS Unit costs and annual costs were estimated from the perspective of service providers. Data for unit costs came from 26 performance sites, and data for annual costs came from 10 programs. A bottom-up approach was used to derive unit costs and included labor, space, and materials used in each SBIRT activity. Activities included direct SBIRT services and activities that support direct service delivery. Labor time spent in each activity was collected by trained observers using a time-and-motion approach. A top-down approach used cost questionnaires completed by program administrators to calculate annual costs and included labor, space, contracted services, overhead, training, travel, equipment, and supplies and materials. Costs were estimated in 2012 U.S. dollars. RESULTS Average unit costs for prescreening, screening, brief intervention, brief treatment, and referral to treatment were $0.61, $6.59, $10.48, $22.63, and $12.06 in ED; $0.86, $6.33, $9.07, $27.61, and $8.03 in inpatient; and $0.84, $3.98, $7.81, $27.94, and $9.23 in outpatient settings, respectively; over half of the costs were attributable to support activities. Across all settings, the average cost to provide SBIRT per positive screen, for 1year, was about $400. CONCLUSIONS Support activities comprise a large proportion of costs. Health administrators can use the results to budget and compare how much sites are reimbursed for SBIRT to how much services actually cost.
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Affiliation(s)
- Carolina Barbosa
- RTI International, 230 West Monroe St., Suite 2100, Chicago, IL 60606-4901.
| | - Alexander J Cowell
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709
| | - Justin Landwehr
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709
| | - William Dowd
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709
| | - Jeremy W Bray
- Bryan School of Business and Economics, 462 Bryan Building, P.O. Box 26170, Greensboro NC 27402-6170
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Magura S, Achtyes ED, Batts K, Platt T, Moore TL. Adding urine and saliva toxicology to SBIRT for drug screening of new patients. Am J Addict 2015; 24:396-9. [DOI: 10.1111/ajad.12252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/18/2015] [Accepted: 05/23/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Eric D. Achtyes
- Cherry Health; Grand Rapids Michigan
- Michigan State University College of Medicine; Grand Rapids Michigan
| | | | | | - Thomas L. Moore
- Western Michigan University; Kalamazoo Michigan
- Cherry Health; Grand Rapids Michigan
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Kalu N, Cain G, McLaurin-Jones T, Scott D, Kwagyan J, Fassassi C, Greene W, Taylor RE. Impact of a multicomponent screening, brief intervention, and referral to treatment (SBIRT) training curriculum on a medical residency program. Subst Abus 2015; 37:242-7. [PMID: 25961140 DOI: 10.1080/08897077.2015.1035841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Substance-related disorders are a growing problem in the United States. The patient-provider setting can serve as a crucial environment to detect and prevent at-risk substance use. Screening, brief intervention, and referral to treatment (SBIRT) is an integrated approach to deliver early intervention and treatment services for persons who have or are at risk for substance-related disorders. SBIRT training components can include online modules, in-person instruction, practical experience, and clinical skills assessment. This paper will evaluate the impact of multiple modes of training on acquisition of SBIRT skills as observed in a clinical skills assessment. METHODS Residents were part of an SBIRT training program, from 2009 through 2013, consisting of lecture, role-play, online modules, patient encounters, and clinical skills assessment (CSA). Differences were assessed across satisfactory and unsatisfactory CSA performance. RESULTS Seventy percent of the residents satisfactorily completed CSA. Demographics, type of components completed, and number of components completed were similar among residents who demonstrated satisfactory clinical skills compared with those who did not. All components of the training program were accepted equally across specialties and resident matriculation cohorts. CONCLUSION The authors conclude that the components employed in SBIRT training do not have to be numerous or of a particular mode of training in order to see observable demonstration of SBIRT skills among medical residents. Thus, residency educators who have limited time or resources may utilize as few as 1 mode of training to effectually disseminate SBIRT skills among health care providers. As SBIRT continues to evolve as a promising tool to address at-risk substance-related disorders, it is critical to train medical residents and other health professionals.
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Affiliation(s)
- Nnenna Kalu
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
| | - Gloria Cain
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
| | - TyWanda McLaurin-Jones
- b Department of Community and Family Medicine , Howard University , Washington , DC , USA
| | - Denise Scott
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
| | - John Kwagyan
- c Georgetown-Howard Universities Center for Clinical and Translation Science (GHUCCTS) , Howard University College of Medicine/Howard University Hospital , Washington , DC , USA
| | - Catsim Fassassi
- d Howard-Hopkins Surgical Outcomes Research Center , Washington , DC , USA.,e Howard University Hospital Trauma and Critical Care , Washington , DC , USA
| | - Wendy Greene
- e Howard University Hospital Trauma and Critical Care , Washington , DC , USA
| | - Robert E Taylor
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
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Bernstein J, Cheng DM, Wang N, Trilla C, Samet J, Saitz R. Recreational drug use among primary care patients: implications of a positive self-report. Ann Fam Med 2015; 13:257-60. [PMID: 25964404 PMCID: PMC4427421 DOI: 10.1370/afm.1750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Should recreational drug use raise clinical concern? We examined the association between weekend-only recreational drug use at baseline (yes vs no) and any increase in recreational drug use frequency or severity over 6 months among primary care patients who screen positive for drug use. In the weekend-only recreational drug use group (52/483 [10.8%]), 54% (28/52) started using drugs on weekdays. Compared with use not limited to weekends, weekend-only use was associated with lower odds of increasing drug use frequency (AOR 0.48, P = 0.03) and lower odds (non-significant) of increasing severity (AOR 0.56, P = 0.07). Although weekend-only recreational drug use appears prognostically less severe, the findings nonetheless suggest that continued episodic monitoring may be clinically wise.
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Affiliation(s)
- Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Na Wang
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts
| | - Caitlin Trilla
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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216
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Ridenour TA, Willis D, Bogen DL, Novak S, Scherer J, Reynolds MD, Zhai ZW, Tarter RE. Detecting initiation or risk for initiation of substance use before high school during pediatric well-child check-ups. Drug Alcohol Depend 2015; 150:54-62. [PMID: 25765481 PMCID: PMC4405881 DOI: 10.1016/j.drugalcdep.2015.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index(©) (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups. DESIGN A high-risk longitudinal design with two cross-sectional replication samples, ages 9-13 was used. Analyses included receiver operating characteristics and regression analyses. PARTICIPANTS A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool. RESULTS YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratios=7.44, CI=4.3-13.0) and conduct problems (odds ratios=7.33, CI=3.9-13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service. CONCLUSIONS Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI's association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders.
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Affiliation(s)
- Ty A. Ridenour
- Research Triangle Institute, Research Triangle Park, NC,University of Pittsburgh, Pittsburgh, PA
| | - David Willis
- Health Resources and Services Administration, Rockville, MD
| | | | - Scott Novak
- Research Triangle Institute, Research Triangle Park, NC
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217
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Dwinnells R. SBIRT as a Vital Sign for Behavioral Health Identification, Diagnosis, and Referral in Community Health Care. Ann Fam Med 2015; 13:261-3. [PMID: 25964405 PMCID: PMC4427422 DOI: 10.1370/afm.1776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of this quasi-experimental design study was to examine the effectiveness of the behavioral health Screening, Brief Intervention, and Referral to Treatment (SBIRT) program at a community health center. The study group was twice as likely (25.3%) to have depression and substance abuse diagnosed compared with the control group (11.4%) (P <.001). Referral rates for the study group were more likely to occur (12.4%) compared with referral rates for the control group (1.0%) (P <.001); however, the kept appointment rates by patients for behavioral health problems referrals remained low for both groups. SBIRT was effectively utilized in a community health center, resulting in increased rates for diagnosis of behavioral health problems and referrals of patients.
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218
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D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 2015; 313:1636-44. [PMID: 25919527 PMCID: PMC4527523 DOI: 10.1001/jama.2015.3474] [Citation(s) in RCA: 610] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Opioid-dependent patients often use the emergency department (ED) for medical care. OBJECTIVE To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine). DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial involving 329 opioid-dependent patients who were treated at an urban teaching hospital ED from April 7, 2009, through June 25, 2013. INTERVENTIONS After screening, 104 patients were randomized to the referral group, 111 to the brief intervention group, and 114 to the buprenorphine treatment group. MAIN OUTCOMES AND MEASURES Enrollment in and receiving addiction treatment 30 days after randomization was the primary outcome. Self-reported days of illicit opioid use, urine testing for illicit opioids, human immunodeficiency virus (HIV) risk, and use of addiction treatment services were the secondary outcomes. RESULTS Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P < .001). The buprenorphine group reduced the number of days of illicit opioid use per week from 5.4 days (95% CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95% CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from 5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief intervention group (P < .001 for both time and intervention effects; P = .02 for the interaction effect). The rates of urine samples that tested negative for opioids did not differ statistically across groups, with 53.8% (95% CI, 42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group (P = .17). There were no statistically significant differences in HIV risk across groups (P = .66). Eleven percent of patients in the buprenorphine group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas 37% in the referral group (95% CI, 27%-48%) and 35% in the brief intervention group (95% CI, 25%-37%) used inpatient addiction treatment services (P < .001). CONCLUSIONS AND RELEVANCE Among opioid-dependent patients, ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services but did not significantly decrease the rates of urine samples that tested positive for opioids or of HIV risk. These findings require replication in other centers before widespread adoption. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00913770.
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Affiliation(s)
- Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patrick G O'Connor
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marek C Chawarski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Susan H Busch
- Yale School of Public Health, New Haven, Connecticut
| | - Patricia H Owens
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut4Yale School of Public Health, New Haven, Connecticut
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Lanken PN, Novack DH, Daetwyler C, Gallop R, Landis JR, Lapin J, Subramaniam GA, Schindler BA. Efficacy of an internet-based learning module and small-group debriefing on trainees' attitudes and communication skills toward patients with substance use disorders: results of a cluster randomized controlled trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:345-354. [PMID: 25295964 DOI: 10.1097/acm.0000000000000506] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine whether an Internet-based learning module and small-group debriefing can improve medical trainees' attitudes and communication skills toward patients with substance use disorders (SUDs). METHOD In 2011-2012, 129 internal and family medicine residents and 370 medical students at two medical schools participated in a cluster randomized controlled trial, which assessed the effect of adding a two-part intervention to the SUDs curricula. The intervention included a self-directed, media-rich Internet-based learning module and a small-group, faculty-led debriefing. Primary study outcomes were changes in self-assessed attitudes in the intervention group (I-group) compared with those in the control group (C-group) (i.e., a difference of differences). For residents, the authors used real-time, Web-based interviews of standardized patients to assess changes in communication skills. Statistical analyses, conducted separately for residents and students, included hierarchical linear modeling, adjusted for site, participant type, cluster, and individual scores at baseline. RESULTS The authors found no significant differences between the I- and C-groups in attitudes for residents or students at baseline. Compared with those in the C-group, residents, but not students, in the I-group had more positive attitudes toward treatment efficacy and self-efficacy at follow-up (P<.006). Likewise, compared with residents in the C-group, residents in the I-group received higher scores on screening and counseling skills during the standardized patient interview at follow-up (P=.0009). CONCLUSIONS This intervention produced improved attitudes and communication skills toward patients with SUDs among residents. Enhanced attitudes and skills may result in improved care for these patients.
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Affiliation(s)
- Paul N Lanken
- Dr. Lanken is associate dean for professionalism and humanism and professor of medicine and medical ethics and health policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Novack is associate dean for medical education and professor of medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. Dr. Daetwyler is associate professor of family medicine and community and preventive medicine and developer of online resources for medical education, Drexel University College of Medicine, Philadelphia, Pennsylvania. Dr. Gallop is instructor in biostatistics, West Chester University, West Chester, Pennsylvania. Dr. Landis is professor and director, Division of Biostatistics, Department of Biostatistics and Epidemiology, and faculty director, Clinical Research Computing Unit, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Lapin is director of graduate medical education evaluation and research, Office of Evaluation and Assessment, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Subramaniam is team leader and medical officer, Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland. Dr. Schindler was vice dean for educational and academic affairs, Drexel University College of Medicine, at the time this study was conducted. She remains professor of psychiatry and pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
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220
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Haley SJ, Kreek MJ. A window of opportunity: maximizing the effectiveness of new HCV regimens in the United States with the expansion of the Affordable Care Act. Am J Public Health 2015; 105:457-63. [PMID: 25602859 PMCID: PMC4330831 DOI: 10.2105/ajph.2014.302327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 12/18/2022]
Abstract
Patients with chronic HCV have predictable overlapping comorbidities that reduce access to care. The Affordable Care Act (ACA) presents an opportunity to focus on the benefits of the medical home model for integrated chronic disease management. New, highly effective HCV treatment regimens in combination with the medical home model could reduce disease prevalence. We sought to address challenges posed by comorbidities in patients with chronic HCV infection and limitations within our health care system, and recommend solutions to maximize the public benefit from ACA and the new drug regimen.
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Affiliation(s)
- Sean J Haley
- Sean J. Haley is with the Department of Health and Nutrition Sciences, Brooklyn College and the City University of New York, School of Public Health, New York. Mary Jeanne Kreek is with the Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York
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221
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Zarkin G, Bray J, Hinde J, Saitz R. Costs of screening and brief intervention for illicit drug use in primary care settings. J Stud Alcohol Drugs 2015; 76:222-8. [PMID: 25785797 PMCID: PMC5374475 DOI: 10.15288/jsad.2015.76.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE In this article, the authors estimate implementation costs for illicit drug screening and brief intervention (SBI) and identify a key source of variation in cost estimates noted in the alcohol SBI literature. This is the first study of the cost of SBI for drug use only. METHOD Using primary data collected from a clinical trial of illicit drug SBI (n = 528) and a hybrid costing approach, we estimated a per-service implementation cost for screening and two models of brief intervention. A taxonomy of activities was first compiled, and then resources and prices were attached to estimate the per-activity cost. Two components of the implementation cost, direct service delivery and service support costs, were estimated separately. RESULTS Per-person cost estimates were $15.61 for screening, $38.94 for a brief negotiated interview, and $252.26 for an adaptation of motivational interviewing. (Amounts are in 2011 U.S. dollars.) Service support costs per patient are 5 to 7.5 times greater than direct service delivery costs per patient. Ongoing clinical supervision costs are the largest component of service support costs. CONCLUSIONS Implementation cost estimates for illicit drug brief intervention vary greatly depending on the brief intervention method, and service support is the largest component of SBI costs. Screening and brief intervention cost estimates for drug use are similar to those published for alcohol SBI. Direct service delivery cost estimates are similar to costs at the low end of the distribution identified in the alcohol literature. The magnitude of service support costs may explain the larger cost estimates at the high end of the alcohol SBI cost distribution.
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Affiliation(s)
- Gary Zarkin
- RTI International, Research Triangle Park, North Carolina
| | - Jeremy Bray
- University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Jesse Hinde
- RTI International, Research Triangle Park, North Carolina,Correspondence may be sent to Jesse Hinde at RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, or via email at:
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
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222
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Gryczynski J, Mitchell SG, Ondersma SJ, O'Grady KE, Schwartz RP. Potential radiating effects of misusing substances among medical patients receiving brief intervention. J Subst Abuse Treat 2015; 55:39-44. [PMID: 25812927 DOI: 10.1016/j.jsat.2015.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/17/2015] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving while impaired. METHODS This study is a secondary analysis from a randomized trial comparing in-person vs. computerized brief intervention among 360 adult community health center patients with moderate-risk illicit drug use (N = 302 with complete data through 12 months of follow-up). This study aims to examine four aspects of PREMiS outcomes in this sample: (1) their frequency; and their association with (2) type of brief intervention received (by random assignment), (3) type of drug misused, and (4) baseline drug problem severity (within the moderate risk range). RESULTS 12-month prevalence was 18.5% for hospitalization (399 cumulative days), 33.1% for emergency department utilization (166 cumulative visits), 39.1% for injury (1818 injury-days), and 8.3% for incarceration (278 days of detention). There were 729 missed work days among those who reported employment. Fifty percent reported driving under the influence (DUI) of substances. There were no differences in PREMiS outcomes by type of brief intervention. Participants with only marijuana misuse at baseline were not at lower risk of experiencing PREMiS events than participants with other drug misuse. Higher baseline drug problem severity was predictive of future hospitalization (p < .05) and number of hospitalization days (p < .01). CONCLUSION This community health center sample with moderate-risk illicit drug use reported considerable high-cost healthcare utilization, injury, missed work, and DUI. Interventions are needed that can reliably lower risk of negative outcomes among drug users.
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Affiliation(s)
| | | | | | - Kevin E O'Grady
- University of Maryland, College Park, Department of Psychology, College Park, MD, USA
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223
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Agley J, Crabb DW, Harris LE, Gassman RA, Gerke SP. An Assessment of SBIRT Prescreening and Screening Outcomes by Medical Setting and Administration Methodology. Health Serv Res Manag Epidemiol 2015; 2:2333392815612476. [PMID: 28462268 PMCID: PMC5266453 DOI: 10.1177/2333392815612476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious prevention practice. However, little research has assessed differences in prescreening outcomes between inpatient and outpatient primary care or among different prescreening administration methods. This study tested whether administration method (self-administered vs interview) and setting (inpatient versus outpatient) predicted prescreening outcomes in a large sample of primary care patients. Then, among patients who prescreened positive, it tested whether full screening scores differed by administration method and setting. METHODS Researchers used binomial logistic regression to assess predicted prescreening outcomes and analysis of variance to assess differences in SBIRT screening scores across a total of 14 447 unique patient visits in 10 outpatient sites and 1 centrally located hospital. RESULTS Controlling for gender, depression, and other substance use, both medical setting and method of prescreening, predicted prescreening results. Among patients who prescreened positive for alcohol, setting also was associated with mean screening scores. However, outcomes were not uniform by substance (eg, alcohol vs other drugs). CONCLUSION The results support previous studies on this topic that had utilized cross-study comparison or that were not specific to SBIRT prescreening/screening mechanisms. At the same time, nuanced findings were observed that had not previously been reported and suggest the need for further research in this area.
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Affiliation(s)
- Jon Agley
- Institute for Research on Addictive Behavior, School of Public Health, Indiana University, Bloomington, IN, USA
| | - David W. Crabb
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa E. Harris
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ruth A. Gassman
- Institute for Research on Addictive Behavior, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Steven P. Gerke
- Indiana University School of Medicine, Indianapolis, IN, USA
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224
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Care of the Patient Who Misuses Drugs. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_67-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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225
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Gryczynski J, Mitchell SG, Gonzales A, Moseley A, Peterson TR, Ondersma SJ, O'Grady KE, Schwartz RP. A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: outcomes through 12 months. J Subst Abuse Treat 2014; 50:3-10. [PMID: 25282578 DOI: 10.1016/j.jsat.2014.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
This study examined outcomes through 12 months from a randomized trial comparing computerized brief intervention (CBI) vs. in-person brief intervention (IBI) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse (N=360). Data were collected at baseline, 3-, 6-, and 12-month follow-up, and included the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and laboratory analysis of hair samples. Repeated measures analyses examined differential change over time. There were no significant differences in drug-positive hair tests over time or by condition. Global ASSIST scores decreased in both conditions (p<.001), but there were no significant differences between conditions in overall change across 12 months of follow-up (p=.13). CBI produced greater overall reductions in alcohol (p=.04) and cocaine (p=.02) ASSIST scores than IBI, with initial differences dissipating over time. Computerized brief interventions present a viable alternative to traditional in-person brief interventions.
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Affiliation(s)
| | | | - Arturo Gonzales
- Sangre de Cristo Community Health Partnership, Santa Fe, NM USA
| | - Ana Moseley
- Sangre de Cristo Community Health Partnership, Santa Fe, NM USA
| | | | | | - Kevin E O'Grady
- University of Maryland, College Park, Department of Psychology, College Park, MD USA
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226
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Saitz R. Screening and brief intervention for unhealthy drug use: little or no efficacy. Front Psychiatry 2014; 5:121. [PMID: 25228887 PMCID: PMC4151000 DOI: 10.3389/fpsyt.2014.00121] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/18/2014] [Indexed: 11/13/2022] Open
Abstract
Unhealthy drug use ranges from use that risks health harms through severe drug use disorders. This narrative review addresses whether screening and brief intervention (SBI), efficacious for risky alcohol use, has efficacy for reducing other drug use and consequences. Brief intervention among those seeking help shows some promise. Screening tools have been validated though most are neither brief nor simple enough for use in general health settings. Several randomized trials have tested the efficacy of brief intervention for unhealthy drug use identified by screening in general health settings (i.e., in people not seeking help for their drug use). Substantial evidence now suggests that efficacy is limited or non-existent. Reasons likely include a range of actual and perceived severity (or lack of severity), concomitant unhealthy alcohol use and comorbid mental health conditions, and the wide range of types of unhealthy drug use (e.g., from marijuana, to prescription drugs, to heroin). Although brief intervention may have some efficacy for unhealthy drug users seeking help, the model of SBI that has effects in primary care settings on risky alcohol use may not be efficacious for other drug use.
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Affiliation(s)
- Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health , Boston, MA , USA ; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine , Boston, MA , USA
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