Implementing brief alcohol intervention in primary and occupational health care. Reflections on two Finnish projects.

Seppä, Kaija; Kuokkanen, Martti

doi:10.1177/145507250802500610

Cited by 9 publications

(9 citation statements)

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“…Studies have identified impediments to Screening and Brief Intervention (SBI) implementation in health-care settings in a variety of countries, including Finland [8,9], Sweden [10,11], Denmark [12], Norway [13], Australia [14] and Brazil [15]. Challenges to conducting SBI include time constraints, the need to focus upon more medically urgent issues, poor training, negative provider attitudes and perceptions of role incompatibility [8,[16][17][18].…”

Section: Sbirt Implementation Barriers and Facilitatorsmentioning

confidence: 99%

Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration

et al. 2017

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Aims To identify barriers and facilitators associated with initial implementation of a US alcohol and other substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program, and to identify modifications in program design that addressed implementation challenges. Design A mixed-method approach used quantitative and qualitative data, including SBIRT provider ratings of implementation barriers and facilitators, staff interview responses and program documentation. Setting Multiple sites within the first seven programs funded in a national demonstration program in the United States. Participants One hundred and two SBIRT providers were surveyed; 221 SBIRT stakeholders and staff were interviewed. Measurements Mean ratings of barriers and facilitators were calculated using provider survey responses. An inductive content analysis of interview responses identified factors perceived to support and challenge implementation; program modifications that occurred over time were recorded. Findings Providers rated pre-selected implementation facilitators higher than barriers. Content analysis of interview responses revealed six themes: committed leaders; intra-and inter-organizational communication/collaboration; provider buy-in and model acceptance; contextual factors; quality assurance; and grant requirements. Over time, programs tended to: adopt more efficient 'pre-screen' item sets; screen for risk factors in addition to alcohol/substance use; use contracted specialists to deliver SBIRT services; conduct services in high-volume emergency department and trauma center settings; and implement on-site and telephonic treatment delivery. Conclusions Screening, Brief Intervention and Referral to Treatment program implementation in the United States is facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Many implementation challenges can be addressed by an adequate start-up phase focused on comprehensive education and training, and on the development of intra-and inter-organizational communication and collaboration; opinion leader support; and practitioner and host site buy-in.

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Section: Sbirt Implementation Barriers and Facilitatorsmentioning

confidence: 99%

Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration

et al. 2017

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“…This was supplemented by a government-funded project starting in 2004 known as the National Brief Intervention Project (VAMP) [38]. With funding of 2.5 million Euros, about 2000 nurses and 1000 general medical practitioners were trained and supported to carry out SBI.…”

Section: Introductionmentioning

confidence: 99%

“…The participating municipalities represented about 25% of the Finnish population, but there was also a concerted attempt to cover the whole country. There was also a separate Occupational Health Care Project in which an additional 2000 health professionals were trained [38]. …”

Section: Introductionmentioning

confidence: 99%

Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

Heather

2012

Addict Sci Clin Pract

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A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners’ (GPs’) advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service’s National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are reviewed, including their political acceptability. It is tentatively concluded that widespread dissemination of SBI, without the implementation of alcohol control measures, might have indirect influences on levels of consumption and harm but would be unlikely on its own to result in public health benefits. However, if and when alcohol control measures were introduced, SBI would still have an important role in the battle against alcohol-related harm.

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“…Several projects world‐wide have made SBI implementation an integral part of everyday health‐care work, utilizing evidence about barriers, flexible tactics and multi‐faceted approaches [24–26]. Overcoming barriers has been slow, but some optimism has emerged in the course of the long history of SBI implementation [8,24].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, in Finland, over a 15‐year period there have been great efforts within several projects to increase health‐care professionals' SBI activity and to encourage positive attitudes towards such questions and advice. Education and training have been essential parts of these projects, as have reminders and support for the professionals, information for inhabitants and campaigns and communication in the regions [26]. The main target group has been professionals working in communal primary and occupational health care.…”

Section: Introductionmentioning

confidence: 99%

Alcohol‐related discussions in health care—a population view

2011

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Implementing brief alcohol intervention in primary and occupational health care. Reflections on two Finnish projects.

Cited by 9 publications

References 0 publications

Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration

Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration

Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

Alcohol‐related discussions in health care—a population view

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