An Assessment of SBIRT Prescreening and Screening Outcomes by Medical Setting and Administration Methodology

Abstract

Background:Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious prevention practice. However, little research has assessed differences in prescreening outcomes between inpatient and outpatient primary care or among different prescreening administration methods. This study tested whether administration method (self-administered vs interview) and setting (inpatient versus outpatient) predicted prescreening outcomes in a large sample of primary care patients. Then, among patients who prescreened positive, it tested whether full screening scores differed by administration method and setting.Methods:Researchers used binomial logistic regression to assess predicted prescreening outcomes and analysis of variance to assess differences in SBIRT screening scores across a total of 14 447 unique patient visits in 10 outpatient sites and 1 centrally located hospital.Results:Controlling for gender, depression, and other substance use, both medical setting and method of prescreening, predicted prescreening results. Among patients who prescreened positive for alcohol, setting also was associated with mean screening scores. However, outcomes were not uniform by substance (eg, alcohol vs other drugs).Conclusion:The results support previous studies on this topic that had utilized cross-study comparison or that were not specific to SBIRT prescreening/screening mechanisms. At the same time, nuanced findings were observed that had not previously been reported and suggest the need for further research in this area.

An Initial Assessment of the Utility of Validated Alcohol and Drug Screening Tools in Predicting 30-Day Readmission to Adult General Medicine Wards

“…Data regarding total hospital admissions and readmissions to the general medical service during the periods of this study (excluding admissions to the intensive care unit [ICU]) were derived from hospital billing records. This study extended the previously reported 35 screening time frame to 18 months to increase the sample size, avoid potential effects of seasonal readmissions (eg, respiratory infections), and because of the potential confounding effect of ongoing projects to reduce readmissions, to determine if the readmission rates were stable. The study team conducted interim analyses at 12 months and, finding results to be similar to the full analysis at 18 months, suggest longitudinal readmission rate stability.…”

“…The team recently published a comparison of rates of likely alcohol misuse using the single question alcohol prescreen (SQS—described in the Methods section) in inpatient and outpatient settings and found a rate of 11% for outpatients, but a rate more than twice as high for inpatients (24.6%), along with significantly higher AUDIT-10 scores for inpatients. 35…”

“…The team recently published a comparison of rates of likely alcohol misuse using the single question alcohol prescreen (SQS-described in the Methods section) in inpatient and outpatient settings and found a rate of 11% for outpatients, but a rate more than twice as high for inpatients (24.6%), along with significantly higher AUDIT-10 scores for inpatients. 35 Based on their prior work, the study team suspected that patients whose AUDIT-10 or DAST-10 scores exceeded predetermined thresholds at the time of admission to the general medicine wards would be more likely to be readmitted within 30 days than those who did not score in such a manner, but that the reasons for readmissions would not necessarily be attributable to substance use. As such, this retrospective study tested the hypothesis that the prevalence of inpatients readmitted within 30 days would be significantly higher in the subpopulation of patients who screened positive on the AUDIT-10 and/ or the DAST-10 than in the population of all adult patients admitted during the same period of time.…”

Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach

“…Data from a large cross-site evaluation from diverse healthcare sites (n = 754,525) indicate that most patients who screen positive are recommended for a brief intervention (BI 68.8%), followed by brief treatment (BT 14.0%) and referral to specialty treatment (RT 17.2%) [15]. However, SBIRT screening in hospital settings tends to identify both a higher frequency of positive screens for alcohol and increased severity level of those screening scores, relative to outpatient primary care, indicating greater likelihood of patients needing referral [16, 17].…”