Implementing a team-based SBIRT model in primary care clinics

Muench, John; Jarvis, Kelly; Gray, Mary; Hayes, Meg; Vandersloot, Denna; Hardman, J. A.; Grover, Peter; Winkle, Jim

doi:10.3109/14659891.2013.866176

Cited by 24 publications

(30 citation statements)

References 25 publications

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“…Performance varied considerably across individual clinics. However, overall rates remained lower than expected; across all clinics, the performance rate for each step hovered around 50% (Muench et al, 2013).…”

Section: Sbirt Implementation Modelmentioning

confidence: 61%

Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes

Muench

Jarvis

Vandersloot

et al. 2015

Alcoholism Treatment Quarterly

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This study implemented a systematized, team-based Screening, Brief Intervention, Referral to Treatment (SBIRT) process in six primary care clinics that incorporated efforts of receptionists, medical assistants, and physicians. Focus groups were conducted to identify key facilitators of and barriers to successful implementation. Buy-in from physicians and clinic leadership and seamless integration of SBIRT into the electronic medical record were noted as 143 144 J. Muench et al.the strongest facilitators. Time constraints and personal discomfort discussing substance use were cited as major barriers. A teambased approach to SBIRT in primary care settings capitalizes on the medical home model but also creates unique barriers.

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Section: Sbirt Implementation Modelmentioning

confidence: 61%

Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes

Muench

Jarvis

Vandersloot

et al. 2015

Alcoholism Treatment Quarterly

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“…Between 2014 and 2016, Interact for Health awarded small grants (all US$60,000 or less) for the implementation of 10 SBIRT programs throughout the greater Cincinnati and Northern Kentucky region in an effort to reduce the number of people with risky substance use, anxiety, and depression. Unlike many previous SBIRT studies [ 19 , 28 , 29 ], each practice chose the condition or conditions for which they would screen, the screening tools, and how they would provide brief intervention and referral to treatment within their setting. An evaluation team from the University of Cincinnati’s Department of Family and Community Medicine (UC DFCM) communicated with each practice in an iterative process throughout the grant period and collected quantitative and qualitative data regarding facilitators and barriers to the SBIRT process.…”

Section: Screening In Primary Care Projectmentioning

confidence: 99%

“…Qualitative data, including open-ended question responses, practice visit notes, and interview notes, were collated and coded using the editing method [ 30 , 31 ]. In this method, while acknowledging the existing literature about SBIRT in primary care [ 6 , 12 – 14 , 18 , 19 , 28 , 32 , 33 ], we sorted the interview data into coding categories derived from the data themselves, explicitly checking them against other categories and the original data, and then searched for patterns and themes. We then returned to the existing literature, and framed our findings as pragmatic best practices for successful implementation of SBIRT in primary care offices.…”

Section: Screening In Primary Care Projectmentioning

confidence: 99%

“…Physicians often mention their lack of time as a major barrier to SBIRT [ 14 , 19 ]. Involving an interprofessional team can mitigate the physician’s role in favor of shared responsibility among all participants in the SBIRT continuum of care [ 18 , 20 , 28 ]. These interprofessional team members need to be involved from the planning stage.…”

Section: Screening In Primary Care Projectmentioning

confidence: 99%

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Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

et al. 2017

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BackgroundScreening, Brief Intervention and Referral to Treatment (SBIRT) is a public health framework approach used to identify and deliver services to those at risk for substance-use disorders, depression, and other mental health conditions. Primary care is the first entry to the healthcare system for many patients, and SBIRT offers potential to identify these patients early and assist in their treatment. There is a need for pragmatic “best practices” for implementing SBIRT in primary care offices geared toward frontline providers and office staff.MethodsTen primary care practices were awarded small community grants to implement an SBIRT program in their location. Each practice chose the conditions for which they would screen, the screening tools, and how they would provide brief intervention and referral to treatment within their setting. An evaluation team communicated with each practice throughout the process, collecting quantitative and qualitative data regarding facilitators and barriers to SBIRT success. Using the editing method, the qualitative data were analyzed and key strategies for success are detailed for implementing SBIRT in primary care.ResultsThe SBIRT program practices included primary care offices, federally qualified health centers, school-based health centers, and a safety-net emergency department. Conditions screened for included alcohol abuse, drug abuse, depression, anxiety, child safety, and tobacco use. Across practices, 49,964 patients were eligible for screening and 36,394 pre-screens and 21,635 full screens were completed. From the qualitative data, eight best practices for primary care SBIRT are described: Have a practice champion; Utilize an interprofessional team; Define and communicate the details of each SBIRT step; Develop relationships with referral partners; Institute ongoing SBIRT training; Align SBIRT with the primary care office flow; Consider using a pre-screening instrument, when available; and Integrate SBIRT into the electronic health record.Conclusions and implicationsSBIRT is an effective tool that can empower primary care providers to identify and treat patients with substance use and mental health problems before costly symptoms emerge. Using the pragmatic best practices we describe, primary care providers may improve their ability to successfully create, implement, and sustain SBIRT in their practices.

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“…The SBIRT Oregon residency training program (www.sbirtoregon.org) taught primary care physicians in federally qualified health centers to conduct SBIRT (Muench et al 2012; Muench et al 2014). One of the participating federally qualified health centers had a large caseload of patients prescribed buprenorphine for opioid dependence.…”

Section: Introductionmentioning

confidence: 99%

Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program

Klimas

Muench

Wiest

et al. 2015

Journal of Psychoactive Drugs

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Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n =208) and in an opioid treatment program (n = 204) over a two year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. Among the patients treated in the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counsellors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested organizational, structural, provider, patient and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.

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Implementing a team-based SBIRT model in primary care clinics

Cited by 24 publications

References 25 publications

Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes

Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program

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