A Multisite Initiative to Increase the Use of Alcohol Screening and Brief Intervention Through Resident Training and Clinic Systems Changes

Seale, J. Paul; Johnson, J. Aaron; Clark, Denice Crowe; Shellenberger, Sylvia; Pusser, Andrea T.; Dhabliwala, Jason; Sigman, Erika J.; Dittmer, None Trenton; Le, Kristy Barnes; Miller, David P.; Clemow, Diana

doi:10.1097/acm.0000000000000846

Cited by 17 publications

(23 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Efforts are under way to improve the quality of alcohol‐related primary care, including implementing preventive screening and brief intervention as well as engaging patients in care for alcohol use disorders (AUD) . As these efforts proceed, health systems need practical, valid approaches to measuring changes in patients’ drinking over time in response to interventions .…”

Section: Introductionmentioning

confidence: 99%

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population

et al. 2016

View full text Add to dashboard Cite

show abstract

“…This checklist has similarities to chart checklists used in other studies of resident SBIRT documentation, but did not include an item to assess for the use of a validated screening tool or assess for the use of prescription medications to help maintain abstinence or referrals for treatment. 17 Faculty participating in the review (MW, KJ, SS, MG, NG) met, practiced using the checklist and agreed upon how the checklist would be applied. Faculty used this checklist to assess the EHR of the 3 patients identified by each resident in advance of a face-to-face CSR meeting.…”

Section: Chart Reviewmentioning

confidence: 99%

“…Few studies have looked at application of skills in clinical practice. 15,16,17 Measurement of drinking outcomes alone may give insufficient credit to residents' attempts at applying their new skills. One method of assessment included in the ACGME/ABMS Toolbox 18 , chart-stimulated recall (CSR), uses the medical record to stimulate the learner's recollection of the patient encounter and explore the rationale behind the clinical decisions made in the visit.…”

Section: Introductionmentioning

confidence: 99%

Teaching Residents Screening, Brief Intervention, and Referral to Treatment (SBIRT) Skills for Alcohol Use: Using Chart-Stimulated Recall to Assess Curricular Impact

et al. 2016

View full text Add to dashboard Cite

Background: Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents’ use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). Methods: Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. Results: Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. Conclusions: More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

show abstract

“…The first in-person session with the clinician was guided by the Southeastern Consortium for Substance Abuse Training (SECSAT) [56], a semistructured interview guide that includes assessing readiness, reviewing drinking patterns and cues, discussing harms or consequences related to drinking, eliciting protective behavior strategies, and developing short-term goals for reducing risky drinking. At the end of the session, the RA returned and demonstrated how to use the sensorband in conjunction with the MtM app.…”

Section: Methodsmentioning

confidence: 99%

Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study

Leonard¹,

Silverman²,

Sherpa³

et al. 2017

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

BackgroundAn increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors.ObjectiveThe aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband.MethodsWe recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected.ResultsQuantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified.ConclusionsDelivering intervention material “just-in-time,” at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies.

show abstract

A Multisite Initiative to Increase the Use of Alcohol Screening and Brief Intervention Through Resident Training and Clinic Systems Changes

Abstract: Resident training combined with clinic implementation efforts can increase the delivery of evidence-based practices such as alcohol SBI in residency clinics.

Cited by 17 publications

References 36 publications

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population

Teaching Residents Screening, Brief Intervention, and Referral to Treatment (SBIRT) Skills for Alcohol Use: Using Chart-Stimulated Recall to Assess Curricular Impact

Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study

Contact Info

Product

Resources

About