Facilitators and Barriers to Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care in Integrated Health Care Settings

Abstract

Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening, but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.

Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study

“…Current estimates suggest that the number of practices across both systems is 82. We elected to recruit all leaders (ie, physician managers) of paediatric primary care practices and all physicians who had seen 100 or more youth patients within the preceding 1 year from each of the 82 practices in the two health systems (n=261; we anticipate 80% recruitment rate for a total of 209) 42. A brief electronic survey will be sent to these clinical leaders and providers to determine acceptability and use of the three firearm components of the Safety Check intervention at that site.…”

“…Sample questions include ‘Asking all caregivers about the presence of firearms in the home would be an acceptable suicide prevention strategy in my practice’ (rated from 1=strongly disagree to 6=strongly agree) and ‘How often do you screen caregivers of youth for the presence of a firearm in the home of youth’ (rated from 0=never to 4=always). All of the items in the survey have undergone cognitive response testing with physician managers and physician providers in paediatric primary care to identify ambiguous wording, awkward instructional sets and portions that may have been difficult to complete 42. Respondents have also evaluated the face validity of the survey during this process.…”

“…We will use publicly available data sources including data from the MHRN data warehouse, which includes a combination of electronic health records, insurance claims data and the National Center for Health Statistics National Vital Statistics System 42. A programmer from each MHRN system will extract information from the data warehouse for participating providers: patient demographics (age, gender, race, ethnicity, patient language, Patient Health Questionnaire-9 (PHQ-9)43 score and diagnostic codes); encounters (e-codes related to suicide and self-inflicted injury)42; provider demographics (specialty, age, gender, race, ethnicity and year graduated); census (socioeconomic indicators for patients based on geocoded patient addresses); public census data (education, income and poverty); and mortality (patient death by suicide; this is only currently available in HFHS).…”

“…A programmer from each MHRN system will extract information from the data warehouse for participating providers: patient demographics (age, gender, race, ethnicity, patient language, Patient Health Questionnaire-9 (PHQ-9)43 score and diagnostic codes); encounters (e-codes related to suicide and self-inflicted injury)42; provider demographics (specialty, age, gender, race, ethnicity and year graduated); census (socioeconomic indicators for patients based on geocoded patient addresses); public census data (education, income and poverty); and mortality (patient death by suicide; this is only currently available in HFHS). Additionally, we will extract youth (aged 12–24) suicide deaths over the past 5 years at the county level for each primary care practice location from the National Vital Statistics System 42. These data will be used as predictor variables in analyses examining characteristics associated with acceptability and use of firearm safety strategies.…”

Influence networks among substance abuse treatment clinics: implications for the dissemination of innovations

“…On the other hand, having just one or two influential clinics in a statewide network poses a greater risk for the interventionist: If the influential clinic leaders form negative opinions of the innovation, they can more effectively block diffusion within the network. This is commonly observed in a substance abuse treatment, as it is for innovations generally [30]. The study from which our data are drawn did not actively attempt to use any of this knowledge in conducting the study, so we cannot assert that either prediction-rapid or blocked dissemination-took place; we can only point out the network structure and how those types of structures have behaved in previous diffusion studies.…”