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Ausman C, Almatar D, Kiepek N. Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:73-96. [PMID: 39114773 PMCID: PMC11302759 DOI: 10.36834/cmej.75973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Background The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion. Objectives The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients. Results Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum. Conclusion To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé.
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Pussig B, Pas L, Li A, Vermandere M, Aertgeerts B, Matheï C. Primary care implementation study to scale up early identification and brief intervention and reduce alcohol-related negative outcomes at the community level (PINO): study protocol for a quasi-experimental 3-arm study. BMC FAMILY PRACTICE 2021; 22:144. [PMID: 34210261 PMCID: PMC8248288 DOI: 10.1186/s12875-021-01479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking. Unfortunately, it remains poorly implemented in daily practice. Multiple studies have shown that training and support (T&S) programs can increase the use of EIBI. Nonetheless, gains have only been modest and short-term at best. Suggestions have been made to rely more on multicomponent programs that simultaneously address several barriers to the implementation of EIBI. The PINO-project aims to evaluate the added value of such a multicomponent program to improve EIBI delivery in daily practice. METHODS/DESIGN A quasi-experimental three-arm implementation study in Flanders (Belgium) will assess the effects of tailored T&S to General Practitioners (GPs) with or without community mobilisation on EIBI delivery in general practice. The study lasts 18 months and will take place in three comparable municipalities. In municipality 1 and 2, GPs receive a tailored T&S program. The T&S is theoretically founded and tailored to the GPs' views, needs and practice characteristics. Furthermore, community actions will be embedded within municipality 1 providing additional, contextual, support. In municipality 3, GPs are offered a minimal intervention to facilitate data collection. The primary outcome is the proportion of adult patients screened for hazardous and harmful alcohol use at the end of an 18-month implementation period. The secondary outcome is the scaling up activity at municipal level in screening rates, as assessed every 3 months, and the proportion of patients who received an additional brief intervention when necessary. Furthermore, the correlation between the opinions and needs of the GP's, their practice organisation and their EIBI performance will be explored. DISCUSSION The PINO-project addresses the gap between what is theoretically possible and the current practice. This is an innovative study combining T&S at GP level with community actions. At the same time, it implements and evaluates practice T&S based on the theoretical domains framework. TRIAL REGISTRATION This trial was approved by the Ethics Committee for Research of UZ/KU Leuven (reference number s63342 and G-2020-2177-R2(MAR)) and is registered on clinicaltrials.gov ( NCT04398576 ) in May 2020.
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Affiliation(s)
- Bram Pussig
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Lodewijk Pas
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Ann Li
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Mieke Vermandere
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Bert Aertgeerts
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Catharina Matheï
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
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Teaching Basic Knowledge on Substance Use Disorders: The Impact of e-Learning on Health Professionals. Clin Ther 2019; 41:2154-2161. [DOI: 10.1016/j.clinthera.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022]
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Tesema L, Marshall J, Hathaway R, Pham C, Clarke C, Bergeron G, Yeh J, Soliman M, McCormick D. Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors. Subst Abus 2018. [PMID: 29513136 DOI: 10.1080/08897077.2018.1449047] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians' lack of experience prescribing this therapy. Little is known about US residency training programs' provision of OBOT and addiction medicine training. METHODS The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs' beliefs about OBOT, and potential barriers to providing OBOT training. RESULTS The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). CONCLUSIONS Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.
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Affiliation(s)
- Lello Tesema
- a Los Angeles County Department of Health Services , Los Angeles , California , USA
| | - Jeffrey Marshall
- b Department of Pulmonary and Critical Care Medicine , Yale University , New Haven , Connecticut , USA
| | - Rachel Hathaway
- c Department of Medicine , Cambridge Health Alliance , Cambridge , Massachusetts , USA
| | - Christina Pham
- d Department of Medicine , University of California , San Francisco , California , USA
| | - Camille Clarke
- e Department of Medicine, School of Medicine , Loma Linda University , Loma Linda , California , USA
| | - Genevieve Bergeron
- c Department of Medicine , Cambridge Health Alliance , Cambridge , Massachusetts , USA
| | - James Yeh
- f Department of Medicine , Brigham and Women's Hospital , Boston , Massachusetts , USA
| | - Michael Soliman
- g Department of Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Danny McCormick
- c Department of Medicine , Cambridge Health Alliance , Cambridge , Massachusetts , USA
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Alford DP, Carney BL, Jackson AH, Brett B, Bridden C, Winter M, Samet JH. Promoting addiction medicine teaching through functional mentoring by co-training generalist chief residents with faculty mentors. Subst Abus 2018; 39:377-383. [PMID: 29452056 DOI: 10.1080/08897077.2018.1439799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Generalist physicians should play a vital role in identifying and managing individuals with substance use but are inadequately trained to do so. METHODS This 5-year (2008-2012) controlled educational study assessed whether internal medicine and family medicine chief residents' (CRs) addiction medicine teaching increased by co-training with faculty mentors at a Chief Resident Immersion Training (CRIT) program in addiction medicine. All CRIT CR attendees identified a residency program faculty mentor to support addiction medicine teaching after CRIT through functional mentoring with a focus on developing and implementing an Addiction Medicine Teaching Project ("Teaching Project"). Approximately half of the CRs attended CRIT with their mentor (co-trained) and half without their mentor (solo-trained). Addiction medicine teaching outcomes were compared between groups using 6- and 11-month questionnaires and 4 bimonthly teaching logs. Of co-trained CRs, mentor characteristics that positively influenced addiction medicine teaching outcomes were identified. RESULTS One hundred CRs from 74 residency programs attended CRIT from 2008 to 2012; 47 co-trained with their mentors and 53 solo-trained without their mentors. At 6-month follow-up, the co-trained CRs were more likely to meet at least monthly with their mentor (22.7% vs. 9.6%, P < .01) and more likely to identify their mentor as a facilitator for Teaching Project implementation (82.2% vs. 38.5%, P < .01). At 11-month follow-up, a higher percentage of co-trained CRs had completed their Teaching Project (34.0% vs. 15.1%, P < .05). Both CR groups had similarly large increases in other addiction medicine teaching outcomes. Mentors with more experience, including years of teaching, was associated with better CR Teaching Project outcomes. CONCLUSIONS Co-training generalist chief residents with a faculty mentor appeared to facilitate functional mentoring-driven Teaching Project implementation but did not further increase already high levels of other addiction medicine teaching. Faculty mentors with more years of teaching experience were more effective in facilitating Teaching Project implementation.
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Affiliation(s)
- Daniel P Alford
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA
| | - Brittany L Carney
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA
| | - Angela H Jackson
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA
| | - Belle Brett
- c Brett Consulting Group , Somerville , Massachusetts , USA
| | - Carly Bridden
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA
| | - Michael Winter
- d Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health , Boston , Massachusetts , USA
| | - Jeffrey H Samet
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA.,e Department of Community Health Sciences , Boston University School of Public Health , Boston , Massachusetts , USA
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Tong S, Sabo R, Aycock R, Prasad R, Etz R, Kuzel A, Krist A. Assessment of Addiction Medicine Training in Family Medicine Residency Programs: A CERA Study. Fam Med 2017; 49:537-543. [PMID: 28724151 PMCID: PMC6996005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Substance use disorder (SUD) is a widespread problem but physicians may feel inadequately prepared to provide addiction care. We sought to assess current addiction medicine curricula in US family medicine residencies (FMRs) and evaluate barriers to improving or implementing addiction medicine curricula. METHODS Questions regarding addiction medicine training were added to the December 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) survey to US FMR program directors to evaluate each FMR's curriculum, potential workforce production, perceived barriers to improving or implementing curricula and faculty training in addiction medicine. RESULTS Of 461 FMR directors, 227 (49.2%) responded; 28.6% reported a required addiction medicine curricula. Regional variations of having a required curriculum ranged from 41.3% in the Northeast to 20.0% in the South (P=0.07). Of residencies, 31.2% had at least one graduate obtain a buprenorphine prescription waiver in the past year and 8.6% had at least one graduate pursue an addiction medicine fellowship in the past 5 years. Lack of faculty expertise was the most commonly cited barrier to having a curriculum, with only 36.2% of programs having at least one buprenorphine waivered faculty member, 9.4% an addiction medicine board certified faculty, and 5.5% a fellowship trained faculty. CONCLUSIONS Few FMRs have addiction medicine curricula and most graduates do not seek additional training. Multifaceted efforts, including developing model national curricula, training existing faculty, and recruiting addiction trained faculty, may improve addiction medicine training in family medicine residencies to better address the growing SUD epidemic.
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Pringle JL, Kearney SM, Rickard-Aasen S, Campopiano MM, Gordon AJ. A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs. Subst Abus 2017; 38:161-167. [DOI: 10.1080/08897077.2017.1288195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Janice L. Pringle
- Program Evaluation and Research Unit, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shannon M. Kearney
- Program Evaluation and Research Unit, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sherry Rickard-Aasen
- Program Evaluation and Research Unit, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Adam J. Gordon
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Abstract
Children whose parents or caregivers use drugs or alcohol are at increased risk of short- and long-term sequelae ranging from medical problems to psychosocial and behavioral challenges. In the course of providing health care services to children, pediatricians are likely to encounter families affected by parental substance use and are in a unique position to intervene. Therefore, pediatricians need to know how to assess a child's risk in the context of a parent's substance use. The purposes of this clinical report are to review some of the short-term effects of maternal substance use during pregnancy and long-term implications of fetal exposure; describe typical medical, psychiatric, and behavioral symptoms of children and adolescents in families affected by substance use; and suggest proficiencies for pediatricians involved in the care of children and adolescents of families affected by substance use, including screening families, mandated reporting requirements, and directing families to community, regional, and state resources that can address needs and problems.
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Merlo LJ, Sutton JA, Gold MS. Brief educational intervention to improve medical student competence in managing patients exposed to secondhand smoke. Subst Abus 2015; 35:163-7. [PMID: 24821353 DOI: 10.1080/08897077.2013.821438] [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] [Indexed: 10/26/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure may lead to the development of various diseases and conditions. One way to reduce SHS exposure is to screen for it within each primary care examination so that appropriate counseling can be directed to affected individuals. There has been little attention to improving medical education about SHS exposure and screening. The goal of this study was to develop an SHS-related educational intervention for medical students, with the purpose of improving knowledge regarding consequences of SHS exposure, and increasing intent to screen patients for exposure. METHODS Medical students (N = 405) were given a measure assessing their knowledge of SHS exposure and intent to screen. Two groups of students served as controls (i.e., a posttest-only group and a pre/posttest group), and one group participated in the SHS education intervention. A factorial analysis with repeated measures and chi-square analyses were used to assess the differences between the groups to determine the impact of the SHS education intervention (ie, online lectures and a standardized patient interaction) on knowledge and intent to screen. RESULTS Results of pretesting demonstrated that medical students had little knowledge of SHS exposure, averaging scores between 63% and 69% on the examination. One control group was reassessed a year later with no educational intervention. They did not demonstrate a significant change in their pre- to posttest scores, although the vast majority (∼95%) reported intending to screen future patients. Students who participated in the SHS educational intervention significantly improved their scores from pre- to posttest (P <.001), and 100% also reported intending to screen future patients. CONCLUSIONS This study suggests that brief education regarding the consequences of SHS exposure may improve medical students' knowledge and increase intent to screen. Future research should assess the long-term impact of educational programs on improved clinical care.
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Affiliation(s)
- Lisa J Merlo
- a Department of Psychology , University of Florida , Gainesville , Florida , USA
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Cucciare MA, Coleman EA, Saitz R, Timko C. Enhancing Transitions from Addiction Treatment to Primary Care. J Addict Dis 2014; 33:340-53. [PMID: 25299380 DOI: 10.1080/10550887.2014.969602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dunn C, Darnell D, Carmel A, Atkins DC, Bumgardner K, Roy-Byrne P. Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings. J Subst Abuse Treat 2014; 51:47-52. [PMID: 25515624 DOI: 10.1016/j.jsat.2014.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/07/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
This quasi experimental study compared the motivational interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 audiorecorded BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40 months post MI training. Both groups met the lower standard (beginning proficiency in MI) on 4 of 5 MI integrity scores, but NRCPs met more of the higher standards (competency in MI) than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity.
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Affiliation(s)
- Chris Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kristin Bumgardner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Kunins HV, Sohler NL, Giovanniello A, Thompson D, Cunningham CO. A buprenorphine education and training program for primary care residents: implementation and evaluation. Subst Abus 2014; 34:242-7. [PMID: 23844954 DOI: 10.1080/08897077.2012.752777] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although substance use disorders are highly prevalent, resident preparation to care for patients with these disorders is frequently insufficient. With increasing rates of opioid abuse and dependence, and the availability of medication-assisted treatment, one strategy to improve resident skills is to incorporate buprenorphine treatment into training settings. METHODS In this study, esidency faculty delivered the BupEd education and training program to 71 primary care residents. BupEd included (1) a didactic session on buprenorphine, (2) an interactive motivational interviewing session, (3) monthly case conferences, and (4) supervised clinical experience providing buprenorphine treatment. To evaluate BupEd, the authors assessed (1) residents' provision of buprenorphine treatment during residency, (2) residents' provision of buprenorphine treatment after residency, and (3) treatment retention among patients treated by resident versus attending physicians. RESULTS Of 71 residents, most served as a covering or primary provider to at least 1 buprenorphine-treated patient (84.5 and 66.2%, respectively). Of 40 graduates, 27.5% obtained a buprenorphine waiver and 17.5% prescribed buprenorphine. Treatment retention was similar between patients cared for by resident PCPs versus attending PCPs (90-day retention: 63.6% [n = 35] vs. 67.9% [n = 152]; P = .55). CONCLUSION These results show that BupEd is feasible, provides residents with supervised clinical experience in treating opioid-dependent patients, and can serve as a model to prepare primary care physicians to care for patients with opioid dependence.
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Affiliation(s)
- Hillary V Kunins
- Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
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Kotz M. Educating providers for the epidemic: the role of AOAAM. J Addict Dis 2013; 32:401-2. [PMID: 24325775 DOI: 10.1080/10550887.2013.859450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Margaret Kotz
- a American Osteopathic Academy of Addiction Medicine
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Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. J Psychoactive Drugs 2013; 44:307-17. [PMID: 23210379 DOI: 10.1080/02791072.2012.720169] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT.
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Affiliation(s)
- Suneel M Agerwala
- University of California, San Francisco, Addiction Medicine Research, Department of Psychiatry, San Francisco, CA, USA
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Stanton MR, Atherton WL, Toriello PJ, Hodgson JL. Implementation of a “Learner-Driven” Curriculum: An Screening, Brief Intervention, and Referral to Treatment (SBIRT) Interdisciplinary Primary Care Model. Subst Abus 2012; 33:312-5. [DOI: 10.1080/08897077.2011.640140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Broyles LM, Rodriguez KL, Kraemer KL, Sevick MA, Price PA, Gordon AJ. A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center. Addict Sci Clin Pract 2012; 7:7. [PMID: 23186245 PMCID: PMC3533719 DOI: 10.1186/1940-0640-7-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 05/02/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. METHODS We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. RESULTS A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills, communication, and collaboration; (2) expanded processes of care and nursing roles; and (3) enhanced electronic medical record features. CONCLUSIONS RCTs of nurse-delivered alcohol BI for hospitalized patients should include consideration of the following elements: comprehensive provider education on alcohol screening, BI and RT; record-keeping systems which efficiently document and plan alcohol-related care; a hybrid model of implementation featuring active roles for interdisciplinary generalists and specialists; and ongoing partnerships to facilitate generation of additional evidence for BI efficacy in hospitalized patients.
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Affiliation(s)
- Lauren Matukaitis Broyles
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, 7180 Highland Drive, Bldg. 2, Rm. 4020W (151C-H), Pittsburgh, PA, 15206, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, 7180 Highland Drive, Bldg. 2, Rm. 4020W (151C-H), Pittsburgh, PA, 15206, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Veterans Engineering Resource Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ann Sevick
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, 7180 Highland Drive, Bldg. 2, Rm. 4020W (151C-H), Pittsburgh, PA, 15206, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Veterans Engineering Resource Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrice A Price
- Critical Care Service Line, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, 7180 Highland Drive, Bldg. 2, Rm. 4020W (151C-H), Pittsburgh, PA, 15206, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
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Pringle JL, Kowalchuk A, Meyers JA, Seale JP. Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project. J Grad Med Educ 2012; 4:58-63. [PMID: 23451308 PMCID: PMC3312535 DOI: 10.4300/jgme-d-11-00019.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 12/01/2011] [Accepted: 12/06/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Screening, Brief Intervention and Referral to Treatment (SBIRT) service for unhealthy alcohol use has been shown to be one of the most cost-effective medical preventive services and has been associated with long-term reductions in alcohol use and health care utilization. Recent studies also indicate that SBIRT reduces illicit drug use. In 2008 and 2009, the Substance Abuse Mental Health Service Administration funded 17 grantees to develop and implement medical residency training programs that teach residents how to provide SBIRT services for individuals with alcohol and drug misuse conditions. This paper presents the curricular activities associated with this initiative. METHODS We used an online survey delivery application (Qualtrics) to e-mail a survey instrument developed by the project directors of 4 SBIRT residency programs to each residency grantee's director. The survey included both quantitative and qualitative data. RESULTS All 17 (100%) grantees responded. Respondents encompassed residency programs in emergency medicine, family medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, and preventive medicine. Thirteen of 17 (76%) grantee programs used both online and in-person approaches to deliver the curriculum. All 17 grantees incorporated motivational interviewing and validated screening instruments in the curriculum. As of June 2011, 2867 residents had been trained, and project directors reported all residents were incorporating SBIRT into their practices. Consistently mentioned challenges in implementing an SBIRT curriculum included finding time in residents' schedules for the modules and the need for trained faculty to verify resident competence. CONCLUSIONS The SBIRT initiative has resulted in rapid development of educational programs and a cohort of residents who utilize SBIRT in practice. Skills verification, program dissemination, and sustainability after grant funding ends remain ongoing challenges.
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