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Blalock DV, Berlin SA, Berkowitz T, Smith VA, Wright C, Bachrach RL, Grubber JM. Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes. Am J Psychiatry 2024; 181:434-444. [PMID: 38706328 PMCID: PMC11076009 DOI: 10.1176/appi.ajp.20230683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes. METHODS This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates. RESULTS Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models. CONCLUSIONS The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.
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Affiliation(s)
- Dan V. Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham NC
| | - Sophia A. Berlin
- Institute for Medical Research, Durham NC
- Durham Veterans Affairs Health Care System, Durham NC
| | - Theodore Berkowitz
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
| | - Valerie A. Smith
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
- Department of Population Health Sciences, Duke University, Durham NC
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | | | - Rachel L. Bachrach
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Janet M. Grubber
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
- Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Health Care System, Boston MA
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Welsh JW, Dopp AR, Durham RM, Sitar SI, Passetti LL, Hunter SB, Godley MD, Winters KC. Narrative review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00140-0. [PMID: 38537736 PMCID: PMC11422521 DOI: 10.1016/j.jaac.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/24/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE In 2014, the U.S. National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018) updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices. METHOD The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research. RESULTS Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research. CONCLUSION These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.
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Adhikari K, Teare GF, Belon AP, Lee B, Kim MO, Nykiforuk C. Screening, brief intervention, and referral to treatment for tobacco consumption, alcohol misuse, and physical inactivity: an equity-informed rapid review. Public Health 2024; 226:237-247. [PMID: 38091812 DOI: 10.1016/j.puhe.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE This rapid review systematically synthesizes evidence of the effectiveness of the Screening, Brief Intervention, and Referral (SBIR/T) approach for tobacco use, alcohol misuse, and physical inactivity. STUDY DESIGN This was a rapid review. METHODS We searched primary studies between 2012 and 2022 in seven electronic databases. The search strategy used concepts related to alcohol-related disorders, intoxication, cigarette, nicotine, physical activity, exercise, sedentary, screening, therapy, and referral. We reviewed both title/abstract and full-text using a priori set inclusion and exclusion criteria to identify the eligible studies. We appraised study quality, extracted data, and summarized the characteristics of the included studies. We applied health equity lenses in the synthesis. RESULTS Of the 44 included studies, most focused on alcohol misuse. SBIR/T improved patients' attitudes toward alcohol behavior change, improved readiness and referral initiation for change, and effectively reduced alcohol consumption. Few studies pertained to smoking and physical inactivity. Most studies on smoking demonstrated effectiveness pertaining to patients' acceptance of referral recommendations, improved readiness and attempts to quitting smoking, and reduced or cessation of smoking. Findings were mixed about the effectiveness of SBIR/T in improving physical activity. Minimal studies exist on the impacts of SBIR/T for these three risk factors on healthcare resource use or costs. Studies considering diverse population characteristics in the design and effectiveness assessment of the SBIR/T intervention are lacking. CONCLUSIONS More research on the impacts of SBIR/T on tobacco use, alcohol misuse, and physical inactivity is required to inform the planning and delivery of SBIR/T for general and disadvantaged populations.
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Affiliation(s)
- K Adhikari
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada.
| | - G F Teare
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada
| | - A P Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - B Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - M O Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - C Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
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Reif S, Brolin M, Beyene TM, D'Agostino N, Stewart MT, Horgan CM. Payment and Financing for Substance Use Screening and Brief Intervention for Adolescents and Adults in Health, School, and Community Settings. J Adolesc Health 2022; 71:S73-S82. [PMID: 36122974 PMCID: PMC9945348 DOI: 10.1016/j.jadohealth.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 10/14/2022]
Abstract
Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address unhealthy substance use. With SBI services expanding beyond healthcare settings (e.g., schools, community organizations) and reaching younger populations, sustainability efforts must consider payment and financing. This narrative review incorporated rapid scoping review methods and a search of the gray literature to determine payment and financing approaches for SBI with adolescents and to describe related barriers and facilitators for its sustainability. We sought information relevant to adolescents and settings in which they receive SBI, but also reviewed sources with an adult focus. Few peer-reviewed articles met inclusion criteria, and those mostly highlighted healthcare settings. School-based settings were better described in the gray literature; little was found about community settings. SBI is mostly paid through grant funding and public and commercial insurance; school-based settings use a range of approaches including grants, public insurance, and other public funding. We call upon researchers and providers to describe the payment and financing of SBI, to inform how the uptake of SBI may be practicable and sustainable. The increasing activation and use of insurance billing codes, and the expansion of SBI beyond healthcare, is encouraging to address unhealthy substance use by adolescents.
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Affiliation(s)
- Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Mary Brolin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Tiginesh M Beyene
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Nicole D'Agostino
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Maureen T Stewart
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Constance M Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Moberg DP, Paltzer J. Clinical Recognition of Substance Use Disorders in Medicaid Primary Care Associated With Universal Screening, Brief Intervention and Referral to Treatment (SBIRT). J Stud Alcohol Drugs 2021; 82:700-709. [PMID: 34762029 PMCID: PMC8819617 DOI: 10.15288/jsad.2021.82.700] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/28/2021] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective for moderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individuals to specialty care, and the literature now often refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in a low-income Medicaid population to evaluate the effect of universal SBIRT on healthcare system recognition of SUDs, a first step to obtaining a referral to treatment (RT) for individuals with SUDs. METHOD SBI patient data from Wisconsin's Initiative to Promote Healthy Lifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. A comparison group of Medicaid beneficiaries was identified from a matched sample of non-SBIRT clinics (total study N = 14,856). Hierarchical generalized linear modeling was used to assess rates of SUD diagnosis in the 12 months following receipt of SBIRT in WIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient's health status, demographics, and baseline substance use diagnoses. RESULTS SBIRT was associated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for any DSM-IV substance abuse or dependence was 9.9% at baseline and 12.2% during the follow-up year. SBIRT patients had 42% (p = .003) greater odds of being diagnosed with a substance use disorder within 12 months relative to comparison clinic patients. However, there were very few claims for specialty SUD services. CONCLUSIONS The presence of SBIRT in a primary care clinic appears to increase the awareness and recognition of patients with SUDs and a greater willingness of healthcare providers to diagnose patients with an alcohol or drug use disorder on Medicaid claims. Further research is needed to determine if this increase in diagnosis reflects integrated care for SUDs or if it leads to improved access to specialty care, in which case abandonment of the RT component of SBIRT may be premature.
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Affiliation(s)
- D. Paul Moberg
- University of Wisconsin–Madison Population Health Institute, Madison, Wisconsin
| | - Jason Paltzer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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Moberg DP, Paltzer J. Clinical Recognition of Substance Use Disorders in Medicaid Primary Care Associated With Universal Screening, Brief Intervention and Referral to Treatment (SBIRT). J Stud Alcohol Drugs 2021; 82:700-709. [PMID: 34762029 PMCID: PMC8819617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/28/2021] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective for moderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individuals to specialty care, and the literature now often refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in a low-income Medicaid population to evaluate the effect of universal SBIRT on healthcare system recognition of SUDs, a first step to obtaining a referral to treatment (RT) for individuals with SUDs. METHOD SBI patient data from Wisconsin's Initiative to Promote Healthy Lifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. A comparison group of Medicaid beneficiaries was identified from a matched sample of non-SBIRT clinics (total study N = 14,856). Hierarchical generalized linear modeling was used to assess rates of SUD diagnosis in the 12 months following receipt of SBIRT in WIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient's health status, demographics, and baseline substance use diagnoses. RESULTS SBIRT was associated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for any DSM-IV substance abuse or dependence was 9.9% at baseline and 12.2% during the follow-up year. SBIRT patients had 42% (p = .003) greater odds of being diagnosed with a substance use disorder within 12 months relative to comparison clinic patients. However, there were very few claims for specialty SUD services. CONCLUSIONS The presence of SBIRT in a primary care clinic appears to increase the awareness and recognition of patients with SUDs and a greater willingness of healthcare providers to diagnose patients with an alcohol or drug use disorder on Medicaid claims. Further research is needed to determine if this increase in diagnosis reflects integrated care for SUDs or if it leads to improved access to specialty care, in which case abandonment of the RT component of SBIRT may be premature.
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Affiliation(s)
- D. Paul Moberg
- University of Wisconsin–Madison Population Health Institute, Madison, Wisconsin
| | - Jason Paltzer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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McCall MH, Wester KL, Bray JW, Hanchate AD, Veach LJ, Smart BD, Wachter Morris C. SBIRT administered by mental health counselors for hospitalized adults with substance misuse or disordered use: Evaluating hospital utilization and costs. J Subst Abuse Treat 2021; 132:108510. [PMID: 34098211 DOI: 10.1016/j.jsat.2021.108510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We analyzed the association of Screening, Brief Intervention, and Referral to Treatment (SBIRT) with hospitalizations, emergency department (ED) visits, and related costs, when administered to inpatients with substance misuse or disordered use by professional mental health counselors. METHODS Our study used retrospective program and health records data and a difference-in-differences design with propensity score covariates. The study population consisted of hospital inpatients admitted to integrated care services staffed by physicians, nurses, and mental health counselors. The intervention group consisted of patients selected for intervention based on substance use history and receiving SBIRT (n = 1577). Patients selected for intervention but discharged before SBIRT administration (n = 618) formed the comparison group. The outcome variables were hospitalization and ED visits costs and counts. Costs of hospitalizations and ED visits were combined to allow sufficient data for analysis, with counts treated similarly. Patient-level variables were substance use type and substance use severity. A cluster variable was inpatient clinical service. Zero-censored and two-part logistic and generalized linear models with robust standard errors tested the association of SBIRT interventions with the outcomes. RESULTS For the full study population of patients using alcohol, illicit drugs, or both, SBIRT administered by mental health counselors was not associated with changes in hospitalizations and ED visits. For patients with alcohol misuse or disordered use, SBIRT by mental health counselors was associated an odds ratio of 0.32 (p < .001) of having subsequent hospitalizations or ED visits. For patients with alcohol use who did return as hospital inpatients or to the ED, SBIRT by counselors was associated with a reduction in costs of $2547 per patient (p < .001) and with an incidence rate ratio of 0.57 for counts (p = .003). CONCLUSION Our results suggest that professional mental health counselors on inpatient integrated care teams may provide SBIRT effectively for patients with misuse and disordered use of alcohol, reducing the likelihood of future healthcare utilization and costs.
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Affiliation(s)
- Marcia H McCall
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Kelly L Wester
- School of Education, The University of North Carolina at Greensboro, 1300 Spring Garden Street, Greensboro, NC 27412, United States of America.
| | - Jeremy W Bray
- Bryan School of Business, The University of North Carolina at Greensboro, 516 Stirling Street, Greensboro, NC 27412, United States of America.
| | - Amresh D Hanchate
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Laura J Veach
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Benjamin D Smart
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Carrie Wachter Morris
- School of Education, The University of North Carolina at Greensboro, 1300 Spring Garden Street, Greensboro, NC 27412, United States of America.
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Choflet A, Hoofring L, Cheng Z, Katulis L, Narang A, Appling S. Substance Use Screening Protocol: Implementation of a System for Patients With Cancer. Clin J Oncol Nurs 2020; 24:554-560. [PMID: 32945788 DOI: 10.1188/20.cjon.554-560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Substance use by patients with a cancer diagnosis may have a detrimental effect on short- and long-term outcomes. Screening, brief intervention, and referral to treatment (SBIRT) has been recommended for all patients in primary care and emergency medicine. OBJECTIVES The purpose of this quality improvement project was to train clinical providers and to implement an effective SBIRT program in a radiation oncology clinic in a comprehensive cancer center. METHODS An interprofessional task force developed a staff training protocol that incorporated oncology-specific content. The team then piloted an SBIRT program in the outpatient clinic. FINDINGS Staff training results were mixed, with only a few evaluation items showing significant improvement. Despite these results, staff training and the implementation of an SBIRT may be valuable in improving substance use screening in this vulnerable population.
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Health Care Utilization After Paraprofessional-administered Substance Use Screening, Brief Intervention, and Referral to Treatment: A Multi-level Cost-offset Analysis. Med Care 2019; 57:673-679. [PMID: 31295165 DOI: 10.1097/mlr.0000000000001162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Authorities recommend universal substance use screening, brief intervention, and referral to treatment (SBIRT) for all (ie, universal) adult primary care patients. OBJECTIVE The objective of this study was to examine long-term (24-mo) changes in health care utilization and costs associated with receipt of universal substance use SBIRT implemented by paraprofessionals in primary care settings. RESEARCH DESIGN This study used a difference-in-differences design and Medicaid administrative data to assess changes in health care use among Medicaid beneficiaries receiving SBIRT. The difference-in-differences estimates were used in a Monte Carlo simulation to estimate potential cost-offsets associated with SBIRT. SUBJECTS The treatment patients were Medicaid beneficiaries who completed a 4-question substance use screen as part of an SBIRT demonstration program between 2006 and 2011. Comparison Medicaid patients were randomly selected from matched clinics in Wisconsin. MEASURES The study includes 4 health care utilization measures: outpatient days; inpatient length of stay; inpatient admissions; and emergency department admissions. Each outcome was assigned a unit cost based on mean Wisconsin Medicaid fee-for-service reimbursement amounts. RESULTS We found an annual increase of 1.68 outpatient days (P=0.027) and a nonsignificant annual decrease in inpatient days of 0.67 days (P=0.087) associated with SBIRT. The estimates indicate that the cost of a universal SBIRT program could be offset by reductions in inpatient utilization with an annual net cost savings of $782 per patient. CONCLUSIONS Paraprofessional-delivered universal SBIRT is likely to yield health care cost savings and is a cost-effective mechanism for integrating behavioral health services in primary care settings.
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Pervanas HC, Landry E, Southard DR, DiNapoli PP, Smith P, Towle J, Barta KS, Fjeld-Sparks K, Stalnaker-Shofner D. Assessment of Screening, Brief Intervention, and Referral to Treatment Training to Interprofessional Health-Care Students. SAGE Open Nurs 2019; 5:2377960819834132. [PMID: 33415228 PMCID: PMC7774338 DOI: 10.1177/2377960819834132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/15/2019] [Accepted: 01/25/2019] [Indexed: 11/17/2022] Open
Abstract
Substance abuse and addiction are responsible for an assortment of health and
financial concerns in the United States. Tools to identify and assist at-risk
persons before they develop a substance use disorder are necessary. Screening,
brief intervention, and referral to treatment (SBIRT) can be utilized by
health-care professionals to identify those at risk to minimize health-related
complications and the potential of developing a substance use disorder. The
primary objective of this study was to provide educational training sessions on
SBIRT to health-care students utilizing interprofessional education activities
and assess perceptions of the training sessions and activities with regard to
confidence to utilize SBIRT in at-risk patients and overall student satisfaction
with SBIRT instruction. The research protocol enrolled students of pharmacy,
nursing, medicine, behavioral health, and physician assistant studies who
received interprofessional SBIRT training. Students completed an anonymous
posttraining online survey, measuring student perceptions of knowledge gained
and confidence to utilize training. A total of 303 students completed the SBIRT
training. Approximately 70% of students were satisfied with the training
materials, instruction, quality, and experience. After training, 78% were
confident that they could perform screening for substance abuse, conduct a brief
intervention (80%), and when to refer to treatment (71%). A total 73% of
students reported that the asynchronous online-based activity was extremely
effective in increasing knowledge of the roles and responsibilities of other
disciplines and providing opportunities to interact with students from other
health professions. Interprofessional education-trained students from multiple
health-care disciplines feel comfortable performing SBIRT to identify persons at
risk for substance misuse in practice.
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Affiliation(s)
| | | | | | | | - Paula Smith
- Southern New Hampshire Area Health Education Center, Raymond, NH, USA
| | | | - Kate Semple Barta
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
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Serrano N, Prince R, Fondow M, Kushner K. Does the Primary Care Behavioral Health Model Reduce Emergency Department Visits? Health Serv Res 2018; 53:4529-4542. [PMID: 29658993 DOI: 10.1111/1475-6773.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the impact of integrating behavioral health services using the primary care behavioral health (PCBH) model on emergency department (ED) utilization. DATA SOURCES Utilization data from three Dane County, Wisconsin hospitals and four primary care clinics from 2003 to 2011. STUDY DESIGN We used a retrospective, quasi-experimental, controlled, pre-post study design. Starting in 2007, two clinics began integrating behavioral health into their primary care practices with a third starting in 2010. A fourth, nonimplementing, community clinic served as control. Change in emergency department and primary care utilization (number of visits) for patients diagnosed with mood and anxiety disorders was the outcomes of interest. DATA COLLECTION Retrospective data were obtained from electronic patient records from the three main area hospitals along with primary care data from participating clinics. PRINCIPAL FINDINGS Following the introduction of the PCBH model, one clinic experienced a statistically significant (p < .01, 95 percent CI 6.3-16.3 percent), 11.3 percent decrease in the ratio of ED visits to primary care encounters, relative to a control site, but two other intervention clinics did not. CONCLUSIONS The PCBH model may be associated with a reduction in ED utilization, but better-controlled studies are needed to confirm this result.
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Affiliation(s)
- Neftali Serrano
- Collaborative Family Healthcare Association, Chapel Hill, NC
| | - Ronald Prince
- Division of Public Health, Wisconsin Department of Health Services, Madison, WI
| | | | - Kenneth Kushner
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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