Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study

Abstract

Background Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs). Methods This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes. Results Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings. Conclusions This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.

Motivational Interviewing Interventions for Harmful Substance Use Amongst Adults in Low- and Middle-Income Countries (LMICs): A Systematic Review

“…Examining the reference lists from the remaining seven articles identified four additional studies [32][33][34][35]. Thus, 11 studies were included in this review [32][33][34][35][36][37][38][39][40][41][42].…”

“…As presented in Table 1, four studies were conducted in South Africa [34,38,41,42], two in Zimbabwe [33,37], two in Kenya [32,36], one in Uganda [35], and two in India [39,40]. Study settings included primary healthcare centres [39,40], emergency centres [42], drop-in centres [32] specialist clinics [33,35], provincial and district hospitals [37], a residential facility [38], a teaching and referral hospital [36], health care services, and NGOs [41].…”

“…The remaining six studies included both men and women. One study focused on men and women on ARV treatment [37], one focused on men and women using heroin and/or opioids [38], one study included participants presenting for an acute visit at an emergency centre [42], one study included participants who would continue their care at a specialist clinic for infectious diseases [35], and one study focused on participants with methamphetamine use disorder and participants on HIV treatment [33].…”

“…Of the four remaining studies two used the ASSIST tool to measure the use of heroin and opioids [38], to measure alcohol and other drugs [42] and one study used the timeline follow-back method (TLFB) to measure the number of days participants had used substances within a specified timeframe and the Penn Alcohol Craving Scale (PACS) (modified for MA dependence) to measure MA use and craving [41].…”

Utilization of Nurse-Administered Screening, Brief Intervention, and Referral to Treatment in a Brief Psychiatric Inpatient Unit

“…SBIRT is an early intervention tool to screen patients for risky substance use, provide brief interventions for those who are found to have risky use, and refer patients with moderate-to-severe substance use to specialty treatment. SBIRT research began in EDs in 1957 (Bernstein et al, 2009), and SBIRT has been used in many settings (Barbosa et al, 2015; D. S. Finnell, 2012) and in other countries (Jun et al, 2019; Van der Westhuizen et al, 2021). The effectiveness of SBIRT in reducing alcohol consumption has been well documented (Hulse & Tait, 2002; Vasilaki et al, 2006).…”