Implementation of alcohol and drug screening, brief intervention, and referral to treatment: Nurse practitioner learner perspectives on a mobile app

Abstract

Background and purpose: Screening, brief Intervention, and referral to treatment (SBIRT) is a widely trained evidence-based strategy to identify and address alcohol and drug use problems. The purpose of this qualitative study was to explore the experience of family nurse practitioner (FNP) learners in the implementation of SBIRT and the perceived clinical utility of an SBIRT mobile app. Methods: Twenty-two FNP learners completed didactic SBIRT training and orientation to an SBIRT mobile app. At the conclusion of the study, participant focus groups explored overall SBIRT delivery (N = 19) and SBIRT mobile app utilization (N = 14). Focus group data were analyzed within a Theory of Planned Behavior framework. Results: Participants indicated that the mobile app was useful in the ongoing development of SBIRT knowledge, skill confidence, and motivation. Learners identified the clinical context as a major factor in facilitating the delivery of SBIRT overall. Participants who did not deliver SBIRT indicated that the most significant barriers to SBIRT implementation were lack of support from clinical preceptors and health systems. Conclusions: Findings suggest that a mobile app is an acceptable and feasible tool to improve the delivery of SBIRT. However, collaboration with preceptors and clinical training organizations is essential to optimize clinical translation.

A Mobile App to Promote Alcohol and Drug SBIRT Skill Translation among Multi-Disciplinary Health Care Trainees: Results of a Randomized Controlled Trial

“…An important observation from the pilot data was the critical influence of the preceptor in supporting the delivery of SBIRT in the clinical training environment. 29 Lack of support from the training environment could have affected rates of SBIRT delivery in both study conditions. The difference in TPB predictor outcomes, with attitudes and social norms as a significant predictor for intent to screen but not actual percent screened, may be explained in part by the influence of the clinical preceptor and training environment overall.…”

“…Another issue of engagement that arose from the qualitative pilot data was the concern trainees had for the use of a personal mobile device in the context of the patient visit. 29 Based on this understanding, study outcomes may have been different if the SBIRT app was nested within a clinic laptop or tablet device. Yardley et al discuss "tailoring and fit" of a DBCI related to health literacy, personal needs and motivations.…”

“…One specific piece of feedback provided by trainees in the pilot was the recommendation to minimize screen navigation on the app. App items that they found particularly engaging were video resources, prompts for substance use screeners, and brief intervention scripts 29 . However, despite the study team's efforts at user-centered design for the SBIRT app, the overall score for usability (62) fell short of the acceptable benchmark (68).…”

The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research

“…Of the 1,856 articles identified in the initial search (after duplicate were removed), 95 met our inclusion criteria, 42–136 the earliest of which was published in 2007. 48 Figure 1 shows the flowchart of the literature search and Supplemental Digital Appendix 3 at http://links.lww.com/ACADMED/B249 provides a summary of each of the included articles.…”

Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department

“…There are other major systemic barriers for individuals reporting their substance use such as stigma, medical neglect, treatment that may be punitive (e.g., forced tapering), involvement with the criminal justice system, involvement with child protective services (especially for pregnant women), and impact on insurance rates/coverage ( Boyd et al, 2022 , McNeil et al, 2014 ; McNeil et al, 2016 ; Simon et al, 2020 ; van Olphen et al, 2006 ; van Olphen et al, 2009 ). In the future, it may be useful to determine methods to encourage patient disclosure and to remediate staff documentation, including strategies to reduce staff burden, in order to optimize care and determine whether either drug type or use severity is associated with linkage to treatment ( Curtis et al, 2019 ; Duber et al, 2018 ; Melnick et al, 2022 ; Uong et al, 2022 ; Wamsley et al, 2018 ).…”