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Mello MJ, Baird J, Spirito A, Lee LK, Kiragu A, Scott K, Zonfrillo MR, Christison-Lagay E, Bromberg J, Ruest S, Pruitt C, Lawson KA, Nasr IW, Aidlen JT, Maxson RT, Becker S. Implementing Screening, Brief Interventions, and Referral to Treatment at Pediatric Trauma Centers: A Step Wedge Cluster Randomized Trial. J Pediatr Surg 2024:S0022-3468(24)00411-1. [PMID: 39097494 DOI: 10.1016/j.jpedsurg.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Pediatric trauma centers have had challenges meeting the American College of Surgeons criteria for screening and intervening for alcohol with adolescent trauma patients. The study objective was to conduct an implementation trial to evaluate the effectiveness of the Science to Service Laboratory (SSL) implementation strategy in improving alcohol and other drugs (AOD) screening, brief intervention, and referral to treatment (SBIRT) delivery at pediatric trauma centers. METHODS Using a stepped wedge cross-over cluster randomized design, 10 US pediatric trauma centers received the SSL implementation strategy to deliver SBIRT with admitted adolescent (12-17 years old) trauma patients. The strategy adapted three core SSL elements: didactic training, performance feedback, and facilitation. The main outcome measured was SBIRT reach. Data were collected from each center's electronic health record (EHR) during pre- and post-implementation wedges (2018-2022). RESULTS EHR data from 8461 adolescent patients were extracted. Aggregated across all sites, the reach of screening with a validated AOD screening tool increased significantly from 25.2% (95% CI: 23.9, 26.5%) of adolescents during pre-implementation to 47.7% (95% CI: 46.3%, 49.2%) post-implementation. There was variability of change across centers. Brief interventions continued to be delivered at high levels to identified adolescents. Referral to primary care providers for further AOD discussion or referral to specialty service for adolescents with high risk use did not improve post-implementation and remained low. CONCLUSIONS The SSL implementation strategy can be successfully utilized by pediatric trauma centers to improve AOD screening, but challenges exist in connecting adolescents for continuation of AOD discussions after discharge. LEVEL OF EVIDENCE Level II, Therapeutic.
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Affiliation(s)
- Michael J Mello
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA.
| | - Janette Baird
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 111 Richmond Street, Providence, RI, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Andrew Kiragu
- Department of Pediatrics, Hennepin County Medical Center, 30 S 8th St, Minneapolis, MN 55415, USA
| | - Kelli Scott
- Northwestern University Feinberg School of Medicine, Center for Dissemination and Implementation Science, 633 N. Saint Clair St., Chicago, IL 60611, USA
| | - Mark R Zonfrillo
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Emily Christison-Lagay
- Yale School of Medicine/Yale New Haven Children's Hospital, Division of Pediatric of Surgery, 1 Park St, New Haven, CT 06510, USA
| | - Julie Bromberg
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Stephanie Ruest
- Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, 55 Claverick St, Providence, RI, USA
| | - Charles Pruitt
- Pediatric Emergency Medicine, Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, USA
| | - Karla A Lawson
- Dell Children's Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, 4900 Mueller Blvd, Austin, TX 78723, USA
| | - Isam W Nasr
- Division of Pediatric Surgery, Johns Hopkins Children's Center, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Jeremy T Aidlen
- Division of Pediatric Surgery, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - R Todd Maxson
- Department of Pediatric Surgery, Arkansas Children's Hospital 1 Children's Way, Little Rock, AR 72202, USA
| | - Sara Becker
- Northwestern University Feinberg School of Medicine, Center for Dissemination and Implementation Science, 633 N. Saint Clair St., Chicago, IL 60611, USA
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Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:42. [PMID: 33975614 PMCID: PMC8111985 DOI: 10.1186/s13011-021-00380-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
Background Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. Methods A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. Results Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. Discussion In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.
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Mudd J, Preston R, Larkins S. Qualitative exploration of barriers to alcohol management in patients with chronic disease in a regional setting. Aust J Prim Health 2021; 26:265-270. [PMID: 32517849 DOI: 10.1071/py19176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/15/2020] [Indexed: 11/23/2022]
Abstract
Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general practitioners. This study explored how staff in general practices are managing alcohol in patients with chronic disease with a view to determining what additional services may be appropriate. Brief interviews were conducted with doctors, nurses and allied health practitioners across three general practices in a regional centre. Interviews were analysed using abductive thematic techniques to elicit broad themes. In all, 18 interviews were conducted. All interviewees found the management of patients with chronic disease who were drinking in excess of guidelines to be challenging. The complexity of patients, in terms of health needs and social circumstances, affected management and self-care. Australian drinking cultural norms also affected patients' and practitioners' behaviour. Multidisciplinary care was highlighted by all health professionals; however, there were challenges maintaining staff motivation, a lack of training in alcohol management and a lack of referral or assistance services. Experienced practitioners identified that the patient was the key stakeholder who needed to take ownership of their health. The combined burden of excess alcohol consumption and chronic disease is a common management challenge faced by staff in general practice. Although there was evidence of awareness of the issue and a concerted effort to address the problem, most staff felt they had inadequate training, skills and resources. More undergraduate or postgraduate training in alcohol management and more resources are required to support general practitioners in this area.
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Affiliation(s)
- Julie Mudd
- James Cook University, College of Medicine and Dentistry, 1 James Cook Drive, Qld 4811, Australia; and Corresponding author.
| | - Robyn Preston
- James Cook University, College of Medicine and Dentistry, 1 James Cook Drive, Qld 4811, Australia; and Central Queensland University, School of Health, Medical and Applied Sciences, 538 Flinders Street, Townsville, Qld 4810, Australia
| | - Sarah Larkins
- James Cook University, College of Medicine and Dentistry, 1 James Cook Drive, Qld 4811, Australia
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Mudd J, Larkins S, Watt K. The effect of alcohol consumption on clinical outcomes in regional patients with chronic disease: a retrospective chart audit. Aust N Z J Public Health 2020; 44:451-456. [PMID: 33044774 DOI: 10.1111/1753-6405.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To better understand the impact of alcohol consumption on the clinical management of chronic diseases in a regional general practice setting. METHODS A retrospective chart audit was undertaken of individual patient records at two large group general practices in Townsville, a regional Australian city. Three common indicator chronic diseases were selected that have clear management guidelines for general practice: type 2 diabetes; chronic obstructive pulmonary disease; and chronic kidney disease. The audits were analysed using SPSS software to examine the association between alcohol consumption on acquisition of clinical management targets and primary disease intermediate outcomes (haemoglobin A1c fraction; per cent of normal forced expiratory volume at one second; and estimated glomerular filtration rate). RESULTS A total of 457 records were audited. Higher-risk alcohol consumption is associated with reduced ability of patients to reach management targets (F[3,453]=3.68; p=0.012) and decreased standardised primary disease outcome (F[3,403]=2.86; p=0.037). CONCLUSION Higher-risk alcohol consumption is associated with reduced attainment of chronic disease management targets and worse chronic disease outcomes. Implications for public health: Alcohol consumption should be assessed frequently in people with chronic disease, especially when there is difficulty acquiring management targets or worsening of disease outcomes without a clear explanation. Better education about the potential associations between alcohol use and chronic disease would benefit those managing these complex conditions, both clinicians and patients.
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Affiliation(s)
- Julie Mudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland.,College of Medicine and Dentistry, James Cook University, Queensland
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Queensland
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
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Erdogan M, Kureshi N, Karim SA, Tallon JM, Asbridge M, Green RS. Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre. BMJ Open 2018; 8:e024190. [PMID: 30429147 PMCID: PMC6252682 DOI: 10.1136/bmjopen-2018-024190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing. DESIGN Retrospective cohort study. SETTING Tertiary trauma centre in Halifax, Canada. PARTICIPANTS 2306 trauma patients who required activation of the trauma team. PRIMARY OUTCOME MEASURE The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing. RESULTS Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend. CONCLUSIONS At this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.
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Affiliation(s)
- Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Nelofar Kureshi
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Saleema A Karim
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John M Tallon
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert S Green
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Successful Implementation of an Alcohol Screening, Brief Intervention, and Referral to Treatment Program. J Trauma Nurs 2018; 25:196-200. [DOI: 10.1097/jtn.0000000000000368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mello MJ, Becker SJ, Bromberg J, Baird J, Zonfrillo MR, Spirito A. Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers-a type III hybrid effectiveness-implementation trial. Implement Sci 2018; 13:35. [PMID: 29471849 PMCID: PMC5824578 DOI: 10.1186/s13012-018-0725-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The American College of Surgeons mandates universal screening for alcohol misuse and delivery of an intervention for those screening positive as a requirement for certification as a level 1 trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging. Our research team completed an implementation study supporting seven pediatric trauma centers' compliance with the requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) policy for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this study is to conduct a fully powered type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use (AOD) in pediatric trauma centers. METHODS Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers that consists of three core elements (i.e., didactic training + performance feedback + leadership coaching). Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. At six distinct time points, each of the 10 sites will provide data from 30 electronic medical records (n = 1800 in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month after hospital discharge. In addition, nurses, social workers, and leaders will report on organizational readiness for implementation at four distinct time points. DISCUSSION This protocol proposes a unique opportunity to examine whether a comprehensive implementation strategy can improve the fidelity of SBIRT delivery across a national cohort of pediatric trauma centers. With injured adolescents, this could optimize the detection and intervention of AOD use and improve adolescent health. TRIAL REGISTRATION Clinicaltrials.gov NCT03297060 .
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Affiliation(s)
- Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA. .,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA.
| | - Sara J Becker
- Department of Behavorial and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Julie Bromberg
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Albert Medical School of Brown University, Providence, RI, USA
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Tran V, Mackenzie S, Hamilton S, Edmonds MJ, Brichko L. Emergency departments and alcohol: The perpetual hangover. Emerg Med Australas 2016; 28:735-738. [PMID: 27800672 DOI: 10.1111/1742-6723.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Viet Tran
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sara Mackenzie
- Emergency Department, Peninsula Health, Melbourne, Victoria, Australia.,Emergency Department, Epworth Health, Melbourne, Victoria, Australia
| | - Suzanne Hamilton
- Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - Michael Jr Edmonds
- Emergency Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Lisa Brichko
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
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