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Multispecialty SBIRT Training in an Academic Medical Center: Resident Training Experience across Specialties.

Thu, 08/27/2015 - 6:00am

Multispecialty SBIRT Training in an Academic Medical Center: Resident Training Experience across Specialties.

Subst Abus. 2015 Aug 26;:0

Authors: Clemence AJ, Balkoski VI, Schaefer BM, Lee M, Bromley N, Maisonneuve IM, Hamilton CJ, Lukowitsky MR, Poston J, Hall S, Pieterse P, Antonikowski A, Glick SD

Abstract
BACKGROUND: The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently begun to fund programs that train medical residents on how to utilize an evidence-based validated system known as Screening, Brief Intervention, and Referral to Treatment (SBIRT) for providing early detection and brief treatment of unhealthy substance use. This paper investigates training outcomes of multispecialty SBIRT training at one such program at Albany Medical Center (AMC), one of the initial SAMHSA grantees.
METHODS: Training outcomes were measured across three domains of learning: trainee satisfaction, acquired knowledge, and perceived usefulness. We explored differences in learning experience by post-graduate year and by specialty.
RESULTS: Overall, residents were highly satisfied with the training, and learning outcomes met objectives. Residents' ratings of usefulness did not vary by program year. However, our results indicate that relative to residents in other programs, residents in Psychiatry and Pediatrics found the training components significantly more useful, while Emergency Medicine residents found training components to have less utility. Residents who found the training relevant to their daily work were more satisfied and more receptive to SBIRT training overall, which may help explain difference scores by program.
CONCLUSIONS: Residents were highly satisfied with SBIRT skills training, although ratings of usefulness varied by residency program. Specialization by program and on-site modeling by senior faculty may enhance trainee satisfaction and perceived usefulness.

PMID: 26308425 [PubMed - as supplied by publisher]

Local implementation of alcohol screening and brief intervention at five Veterans Health Administration primary care clinics: Perspectives of clinical and administrative staff.

Tue, 08/25/2015 - 6:00am
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Local implementation of alcohol screening and brief intervention at five Veterans Health Administration primary care clinics: Perspectives of clinical and administrative staff.

J Subst Abuse Treat. 2015 Jul 26;

Authors: Williams EC, Achtmeyer CE, Young JP, Rittmueller SE, Ludman EJ, Lapham GT, Lee AK, Chavez LJ, Berger D, Bradley KA

Abstract
BACKGROUND AND OBJECTIVE: Population-based alcohol screening, followed by brief intervention for patients who screen positive for unhealthy alcohol use, is widely recommended for primary care settings and considered a top prevention priority, but is challenging to implement. However, new policy initiatives in the U.S., including the Affordable Care Act, may help launch widespread implementation. While the nationwide Veterans Health Administration (VA) has achieved high rates of documented alcohol screening and brief intervention, research has identified quality problems with both. We conducted a qualitative key informant study to describe local implementation of alcohol screening and brief intervention from the perspectives of frontline adopters in VA primary care in order to understand the process of implementation and factors underlying quality problems.
METHODS: A purposive snowball sampling method was used to identify and recruit key informants from 5 VA primary care clinics in the northwestern U.S. Key informants completed 20-30 minute semi-structured interviews, which were recorded, transcribed, and qualitatively analyzed using template analysis.
RESULTS: Key informants (N=32) included: clinical staff (n=14), providers (n=14), and administrative informants (n=4) with varying participation in implementation of and responsibility for alcohol screening and brief intervention at the medical center. Ten inter-related themes (5 a priori and 5 emergent) were identified and grouped into 3 applicable domains of Greenhalgh's conceptual framework for dissemination of innovations, including values of adopters (theme 1), processes of implementation (themes 2 and 3), and post-implementation consequences in care processes (themes 4-10). While key informants believed alcohol use was relevant to health and important to address, the process of implementation (in which no training was provided and electronic clinical reminders "just showed up") did not address critical training and infrastructure needs. Key informants lacked understanding of the goals of screening and brief intervention, believed referral to specialty addictions treatment (as opposed to offering brief intervention) was the only option for following up on a positive screen, reported concern regarding limited availability of treatment resources, and lacked optimism regarding patients' interest in seeking help.
CONCLUSIONS: Findings suggest that the local process of implementing alcohol screening and brief intervention may have inadequately addressed important adopter needs and thus may have ultimately undermined, instead of capitalized on, staff and providers' belief in the importance of addressing alcohol use as part of primary care. Additional implementation strategies, such as training or academic detailing, may address some unmet needs and help improve the quality of both screening and brief intervention. However, these strategies may be resource-intensive and insufficient for comprehensively addressing implementation barriers.

PMID: 26297322 [PubMed - as supplied by publisher]

SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers.

Tue, 08/25/2015 - 6:00am
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SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers.

J Subst Abuse Treat. 2015 Jun 26;

Authors: Mitchell SG, Schwartz RP, Kirk AS, Dusek K, Oros M, Hosler C, Gryczynski J, Barbosa C, Dunlap L, Lounsbury D, O'Grady KE, Brown BS

Abstract
BACKGROUND: Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study.
METHODS: This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability.
DISCUSSION: The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.

PMID: 26297321 [PubMed - as supplied by publisher]

The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility.

Tue, 08/25/2015 - 6:00am
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The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility.

Drug Alcohol Depend. 2015 Jul 23;

Authors: Boudreaux ED, Haskins B, Harralson T, Bernstein E

Abstract
BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model.
METHODS: Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1-3. (5) Modified Patient Choice: choice of models 1-2, Electronic Referral offered if 1-2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates.
RESULTS: Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ(2) (4, N=50)=34.8, p<0.001.
CONCLUSIONS: The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable.

PMID: 26297297 [PubMed - as supplied by publisher]

Implementing Substance Abuse Intervention Services in New York City Sexually Transmitted Disease Clinics: Factors Promoting Interagency Collaboration.

Sun, 08/16/2015 - 6:00am
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Implementing Substance Abuse Intervention Services in New York City Sexually Transmitted Disease Clinics: Factors Promoting Interagency Collaboration.

J Behav Health Serv Res. 2015 Aug 15;

Authors: Appel PW, Warren BE, Yu J, Rogers M, Harris B, Highsmith S, Davis C

Abstract
This report presents results of Project LINK, a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded, 5-year collaboration (2007-2012) between New York City (NYC) health and NY State substance abuse disorder (SUD) agencies, an LGBT organization contractor, and multiple SUD, social service, and mental health referral agencies. LINK allowed the first ever SUD screening, brief intervention, and referrals to treatment (SBIRT) intervention services onsite in NYC Bureau of Sexually Transmitted Disease Control (BSTDC) clinics. Factors favoring collaboration were (a) joint recognition of substance abuse as an STD risk factor; (b) prior collaborations; (c) agreement on priority of BSTDC's mission and policies; (d) extensive SBIRT training, cross training on STDs; (e) a memorandum of agreement; and (f) mutual transparency of collaborative efforts, among others. LINK screened over 151,000 STD clinic patients and delivered brief interventions to 60% of positively screened patients and met a mandated follow-up target. Factors found to facilitate collaboration here may help screen prospective new health collaborations.

PMID: 26276420 [PubMed - as supplied by publisher]

Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects

Fri, 08/14/2015 - 6:00am

Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects

Book. 2015

Authors: Kobeissy FH

Abstract
A biomarker is a qualitative and quantitative biological substance or characteristic that defines a certain pathological condition and may give indications on disease severity and the type of therapy that should be administered to the patient. Traumatic brain injury (TBI) is an ever-growing public health concern, where the annual number of TBI patients reaches a staggering number of around 1.7 million cases in the United States alone. It is important that we continue the pursuit for the ideal TBI biomarker in order to decrease the number of fatalities secondary to TBI, and its direct and indirect costs. However, the path towards reaching a surrogate endpoint biomarker is not easy but rather long and needs time and effort. In this chapter, we discuss the process of assessment and validation through which a biomarker passes through in order to be finally established as a TBI biomarker and approved by the FDA. We also provide a brief history on TBI biomarkers, discuss the different types and sources of biomarkers and give a summary of TBI biomarkers currently in use and their potential clinical application. The term “biomarker” refers to objective and quantifiable characteristics of biological processes that can define a normal or a pathogenic state. Biomarkers can be identified as a broad subcategory of medical signs, which, by accurate measures and reproducibility, can provide an objective suggestion of the medical state examined from outside the patient. With evolving technology, we are able to better detect, identify, and quantify biomarkers and validate them in the clinical setting. The use of the term biomarker dates back to as early as 1980 (Atkinson et al., 2001). Many precise definitions of biomarkers are found in the literature, and their contexts overlap. In 1998, the National Institutes of Health Biomarkers Definitions Working Group defined a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” (Strimbu and Tavel, 2010). The National Academy of Sciences defines a biomarker as an indicator that signals events in biological samples or systems (Committee on Biological Markers of the National Research Council, 1987). In addition, the International Program on Chemical Safety, led by the World Health Organization (WHO) and in coordination with the United Nations and the International Labor Organization, has defined a biomarker as “any substance, structure, or process that can be measured in the body, or its products and influences or predicts the incidence of outcome or disease” (WHO, 2001). In its report on the validity of biomarkers in the environmental risk assessment, the WHO went even more broadly with its definition, stating that “a biomarker includes almost any measurement reflecting an interaction between a biological system and a potential hazard, which may be chemical, physical, or biological. The measured response may be functional, physiological and biochemical at the cellular level, or a molecular interaction” (WHO, 1993). All these terms, definitions, and characteristics were proposed to describe a biomarker, indicating that it may have the greatest value in early efficacy and safety evaluations, such as in vitro studies in tissue samples, in vivo studies in animal models, and early-phase clinical trials, to establish “proof of concept” (Atkinson et al., 2001). Yet, biomarkers may have many other important applications in detecting diseases and monitoring the health status of a patient. As Atkinson et al. stated, these applications include the use of such biomarkers as a diagnostic tool to identify patients with a possible disease or abnormal condition, such as hyperglycemia for the diagnosis of diabetes mellitus (Atkinson et al., 2001). Moreover, biomarkers can be used as a method to predict the stage of the disease and its severity such as measuring the concentration of prostate-specific antigen (PSA) in the blood to detect the level of tumor growth and metastasis, even though different clinical trials are currently having conflicting results about the efficacy of this biomarker (Acimovic et al., 2013; Haines and Gabor Miklos, 2013; Izumi et al., 2014; Pataky et al., 2014). Also, they can be used as an indicator of disease prognosis or a predictor of clinical response to an intervention whereby, for example, biomarkers can be measured to detect tumor shrinkage or regression in certain cancers (Everson et al., 2014; Okegawa et al., 2014) or determine the risk of heart disease (Eapen et al., 2014; Ligthart et al., 2014).


PMID: 26269914

Emergency Physician Utilization of Alcohol/Substance Screening, Brief Advice and Discharge: A 10-Year Comparison.

Tue, 08/04/2015 - 6:00am
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Emergency Physician Utilization of Alcohol/Substance Screening, Brief Advice and Discharge: A 10-Year Comparison.

J Emerg Med. 2015 Jul 30;

Authors: Broderick KB, Kaplan B, Martini D, Caruso E

Abstract
BACKGROUND: In 2007, of the 130 million emergency department (ED) visits, ∼ 38 million were due to injury, and of those, 1.9 million involved alcohol. The emergency department is a pivotal place to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) due to the high number of patients presenting with alcohol/substance abuse risk factors or related injuries.
STUDY OBJECTIVE: This study compares two surveys, approximately 11 years apart, of emergency physicians nationwide which assesses the use of validated screening tools, the availability of community resources for alcohol/substance abuse treatment, and the prevailing attitudes of emergency physicians regarding Screening and Brief Intervention for alcohol/substance abuse.
METHODS: We performed cross-sectional anonymous surveys of 1500 emergency physicians drawn from American College of Emergency Physicians members. The survey results were compared for time interval change.
RESULTS: The two surveys had comparable response rates. The median percentage of patients screened for alcohol/substance abuse in 1999 was 15%, vs. 20% in 2010. In 2010, 26% of emergency physicians had a formal screening tool, and the majority used Cut-down, Annoyed, Guilty, Eye-opener (85%). In 2010, a statistically significant increase in the number of emergency physicians said they would "always" or "almost always" use discharge instructions that were specific for alcohol/substance abuse, if available, vs. 1999.
CONCLUSION: Few emergency physicians screen for alcohol/substance abuse despite evidence that screening and brief intervention is effective. Emergency physicians are receptive to the use of discharge material.

PMID: 26234716 [PubMed - as supplied by publisher]

Implementing effective substance abuse treatments in general medical settings: Mapping the research terrain.

Tue, 08/04/2015 - 6:00am
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Implementing effective substance abuse treatments in general medical settings: Mapping the research terrain.

J Subst Abuse Treat. 2015 Jul 8;

Authors: Ducharme LJ, Chandler RK, Harris AH

Abstract
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described.

PMID: 26233697 [PubMed - as supplied by publisher]

Screening and Brief Interventions for Alcohol and Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units in Cape Town, South Africa: A Qualitative Study of the Views of Health Care Professionals.

Thu, 07/30/2015 - 6:00am
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Screening and Brief Interventions for Alcohol and Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units in Cape Town, South Africa: A Qualitative Study of the Views of Health Care Professionals.

J Midwifery Womens Health. 2015 Jul 28;

Authors: Petersen Williams P, Petersen Z, Sorsdahl K, Mathews C, Everett-Murphy K, Parry CD

Abstract
INTRODUCTION: Despite the negative consequences of alcohol and other drug use during pregnancy, few interventions for pregnant women are implemented, and little is known about their feasibility and acceptability in primary health care settings in South Africa. As part of the formative phase of screening, brief intervention, and referral to treatment for substance use among women presenting for antenatal care, the present study explored health care workers' attitudes and perceptions about screening, brief intervention, and referral to treatment among this population.
METHODS: Forty-three health care providers at 2 public sector midwife obstetric units in Cape Town, South Africa, were interviewed using an open-ended, semistructured interview schedule designed to identify factors that hinder or support the implementation of screening, brief intervention, and referral to treatment for substance use in these settings. Transcribed interviews were analyzed using the framework approach.
RESULTS: Health care providers agreed that there is a substantial need for screening, brief intervention, and referral to treatment for substance use among pregnant women and believe such services potentially could be integrated into routine care. Several women-, staff-, and clinic-level barriers were identified that could hinder the successful implementation in antenatal services. These barriers included the nondisclosure of alcohol and other drug use, the intervention being considered as an add-on service or additional work, negative staff attitudes toward implementation of an intervention, poor staff communication styles such as berating women for their behavior, lack of interest from staff, time constraints, staff shortages, overburdened workloads, and language barriers.
DISCUSSION: The utility of screening, brief intervention, and referral to treatment for addressing substance use among pregnant women in public health midwife obstetric units was supported, but consideration will need to be given to addressing a variety of barriers that have been identified.

PMID: 26220766 [PubMed - as supplied by publisher]

Online Versus In-Person Screening, Brief Intervention, and Referral to Treatment Training in Pediatrics Residents.

Wed, 07/29/2015 - 6:00am
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Online Versus In-Person Screening, Brief Intervention, and Referral to Treatment Training in Pediatrics Residents.

J Grad Med Educ. 2015 Mar;7(1):53-8

Authors: Giudice EL, Lewin LO, Welsh C, Crouch TB, Wright KS, Delahanty J, DiClemente CC

Abstract
BACKGROUND: Pediatricians underestimate the prevalence of substance misuse among children and adolescents and often fail to screen for and intervene in practice. The American Academy of Pediatrics recommends training in Screening, Brief Intervention, and Referral to Treatment (SBIRT), but training outcomes and skill acquisition are rarely assessed.
OBJECTIVE: We compared the effects of online versus in-person SBIRT training on pediatrics residents' knowledge, attitudes, behaviors, and skills.
METHODS: Forty pediatrics residents were randomized to receive either online or in-person training. Skills were assessed by pre- and posttraining standardized patient interviews that were coded for SBIRT-adherent and -nonadherent behaviors and global skills by 2 trained coders. Thirty-two residents also completed pre- and postsurveys of their substance use knowledge, attitudes, and behaviors (KABs). Two-way repeated measures multivariate analyses of variance (MANOVAs) and analyses of variance (ANOVAs) estimates were used to assess group differences in skill acquisition and KABs.
RESULTS: Findings indicated that both groups demonstrated skill improvement from pre- to postassessment. Results indicated that both groups increased their knowledge, self-reported behaviors, confidence, and readiness with no significant between-group differences. Follow-up univariate analyses indicated that, while both groups increased their SBIRT-adherent skills, the online training group displayed more "undesirable" behaviors posttraining.
CONCLUSIONS: The current study indicates that brief training, online or in-person, can increase pediatrics residents' SBIRT skills, knowledge, self-reported behaviors, confidence, and readiness. The findings further indicate that in-person training may have incremental benefit in teaching residents what not to do.

PMID: 26217423 [PubMed - in process]

A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): the study protocol.

Thu, 07/23/2015 - 6:00am
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A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): the study protocol.

BMJ Open. 2014;4(12):e007130

Authors: López-Pelayo H, Wallace P, Segura L, Miquel L, Díaz E, Teixidó L, Baena B, Struzzo P, Palacio-Vieira J, Casajuana C, Colom J, Gual A

Abstract
INTRODUCTION: Early identification (EI) and brief interventions (BIs) for risky drinkers are effective tools in primary care. Lack of time in daily practice has been identified as one of the main barriers to implementation of BI. There is growing evidence that facilitated access by primary healthcare professionals (PHCPs) to a web-based BI can be a time-saving alternative to standard face-to-face BIs, but there is as yet no evidence about the effectiveness of this approach relative to conventional BI. The main aim of this study is to test non-inferiority of facilitation to a web-based BI for risky drinkers delivered by PHCP against face-to-face BI.
METHOD AND ANALYSIS: A randomised controlled non-inferiority trial comparing both interventions will be performed in primary care health centres in Catalonia, Spain. Unselected adult patients attending participating centres will be given a leaflet inviting them to log on to a website to complete the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol screening questionnaire. Participants with positive results will be requested online to complete a trial module including consent, baseline assessment and randomisation to either face-to-face BI by the practitioner or BI via the alcohol reduction website. Follow-up assessment of risky drinking will be undertaken online at 3 months and 1 year using the full AUDIT and D5-EQD5 scale. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. Assuming reduction of 30% of risky drinkers receiving standard intervention, 1000 patients will be required to give 90% power to reject the null hypothesis.
ETHICS AND DISSEMINATION: The protocol was approved by the Ethics Commmittee of IDIAP Jordi Gol i Gurina P14/028. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02082990.

PMID: 25552616 [PubMed - indexed for MEDLINE]

Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

Sat, 07/18/2015 - 6:00am
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Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

Acad Pediatr. 2015 Jul 13;

Authors: Colvin JD, Bettenhausen JL, Anderson-Carpenter KD, Collie-Akers V, Plencner L, Krager M, Nelson B, Donnelly S, Simmons J, Higinio V, Chung PJ

Abstract
OBJECTIVE: It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting.
METHODS: During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use.
RESULTS: A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months).
CONCLUSIONS: A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.

PMID: 26183003 [PubMed - as supplied by publisher]

Residents' Experience of SBIRT as a Clinical Tool Following Practical Application: A Mixed Methods Study.

Thu, 07/16/2015 - 6:00am

Residents' Experience of SBIRT as a Clinical Tool Following Practical Application: A Mixed Methods Study.

Subst Abus. 2015 Jul 15;:0

Authors: Clemence AJ, Balkoski VI, Lee M, Poston J, Schaefer BM, Maisonneuve IM, Bromley N, Lukowitsky M, Pieterse P, Antonikowski A, Hamilton CJ, Hall S, Glick SD

Abstract
BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based validated system for providing early detection and brief treatment of substance use disorders, has been widely used in the training of medical residents across specialties at a number of sites. This paper investigates the effectiveness of SBIRT training during short-term follow-up at Albany Medical Center, one of the initial SAMHSA grantees.
METHODS: Training outcomes were measured by training satisfaction following opportunities to apply SBIRT skills in clinical work, the rate at which these techniques were applied in clinical work, and the degree to which residents felt the SBIRT training provided skills that were applicable to their practice. We examined differences in learning experience by post-graduate year and by program, and conducted a qualitative analysis in a convergent parallel mixed methods design to elucidate barriers encountered by residents upon using SBIRT techniques in clinical practice.
RESULTS: Residents remained highly satisfied with the training at four-month follow-up, with 80.1% reporting that they had used SBIRT skills in their clinical work. Use of SBIRT techniques was high at 6-month follow-up as well, with 85.9% of residents reporting that they regularly screened their patients for substance use, 74.4% reporting that they had applied brief intervention techniques, and 78.2% indicating that SBIRT training had made them overall more effective in helping patients with substance use issues. Differences in application rates and satisfaction were found by specialty. Qualitative analyses indicated that residents encountered patient readiness and specific contextual factors, such as time constraints, externally imposed values, and clinical norms, as barriers to implementation.
CONCLUSIONS: Despite encountering obstacles such as time constraints and patient readiness, residents utilized many of the skills they had learned during SBIRT training in clinical practice and reported finding these skills useful in their management of patients with substance use issues.

PMID: 26176589 [PubMed - as supplied by publisher]

Effectiveness of yogic breathing intervention on quality of life of opioid dependent users.

Wed, 07/15/2015 - 6:30am
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Effectiveness of yogic breathing intervention on quality of life of opioid dependent users.

Int J Yoga. 2015 Jul-Dec;8(2):144-7

Authors: Dhawan A, Chopra A, Jain R, Yadav D, Vedamurthachar

Abstract
INTRODUCTION: The quality of life (QOL) of substance users is known to be impaired. Sudarshan Kriya Yoga (SKY), a yogic breathing program has potential to improve QOL and needs evaluation in an Indian setting.
AIMS: Study aimed to assess changes in QOL in treatment seeking male opioid dependent users following practice of SKY program.
SETTINGS AND DESIGN: Users were randomized into study (n = 55) and control group (n = 29). Study group besides standard treatment (long term pharmacotherapy with buprenorphine in flexible dosing schedule) underwent a 3 days, 12 h SKY program while control group received standard treatment alone.
MATERIALS AND METHODS: World Health Organization QOL-brief scale was used to measure QOL and urine tested to assess recent drug use. Assessments were made at baseline and at 3 and 6 months.
STATISTICAL ANALYSIS: Data were analyzed using generalized estimation equation to assess within group change with time and the overall difference between groups for changes at assessment points.
RESULTS: Overtime within study group, all four QOL domain scores were significantly higher at 6 months. Between group comparison showed significant increase in physical (P < 0.05); psychological (P < 0.001) and environment domains (P < 0.001) for study group while control group showed significant changes in social relationship domain only. Urine screening results were negative for study group indicating no drug use at 6 months.
CONCLUSION: SKY as a complementary therapy was found beneficial in improving QOL for group practicing it and is recommended for use as low cost and low-risk adjunct in substance treatment settings in India.

PMID: 26170596 [PubMed]

Cost of Screening, Brief Intervention, and Referral to Treatment in Health Care Settings.

Sat, 07/11/2015 - 6:00am

Cost of Screening, Brief Intervention, and Referral to Treatment in Health Care Settings.

J Subst Abuse Treat. 2015 Jun 18;

Authors: Barbosa C, Cowell AJ, Landwehr J, Dowd W, Bray JW

Abstract
AIMS: This study analyzed service unit and annual costs of substance abuse screening, brief intervention, and referral to treatment (SBIRT) programs implemented in emergency department (ED), inpatient, and outpatient medical settings in three U.S. states and one tribal organization.
METHODS: Unit costs and annual costs were estimated from the perspective of service providers. Data for unit costs came from 26 performance sites, and data for annual costs came from 10 programs. A bottom-up approach was used to derive unit costs and included labor, space, and materials used in each SBIRT activity. Activities included direct SBIRT services and activities that support direct service delivery. Labor time spent in each activity was collected by trained observers using a time-and-motion approach. A top-down approach used cost questionnaires completed by program administrators to calculate annual costs and included labor, space, contracted services, overhead, training, travel, equipment, and supplies and materials. Costs were estimated in 2012 U.S. dollars.
RESULTS: Average unit costs for prescreening, screening, brief intervention, brief treatment, and referral to treatment were $0.61, $6.59, $10.48, $22.63, and $12.06 in ED; $0.86, $6.33, $9.07, $27.61, and $8.03 in inpatient; and $0.84, $3.98, $7.81, $27.94, and $9.23 in outpatient settings, respectively; over half of the costs were attributable to support activities. Across all settings, the average cost to provide SBIRT per positive screen, for 1year, was about $400.
CONCLUSIONS: Support activities comprise a large proportion of costs. Health administrators can use the results to budget and compare how much sites are reimbursed for SBIRT to how much services actually cost.

PMID: 26160162 [PubMed - as supplied by publisher]

Predictors and moderators of aftercare appointment-keeping following brief motivational interviewing among patients with psychiatric disorders or dual diagnosis.

Sat, 07/11/2015 - 6:00am
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Predictors and moderators of aftercare appointment-keeping following brief motivational interviewing among patients with psychiatric disorders or dual diagnosis.

J Dual Diagn. 2014;10(1):44-51

Authors: Pantalon MV, Murphy MK, Barry DT, Lavery M, Swanson AJ

Abstract
OBJECTIVE: Non-adherence to psychiatric and substance abuse treatment recommendations, especially with regard to aftercare outpatient appointment-keeping following hospitalizations, exacts a high cost on mental health spending and prevents patients from receiving therapeutic doses of treatment. Our primary objective was to evaluate the relationship between potential predictors and moderators of aftercare appointment-keeping among a group of adult patients immediately following hospitalization for severe psychiatric disorders or dual diagnosis.
METHODS: Candidate predictors and moderator variables included demographics, psychiatric status, psychiatric symptom severity, and inpatient group adherence, while aftercare appointment-keeping was defined as attendance at the first aftercare appointment. Participants were 121 adult inpatients with a psychiatric disorder or dual diagnosis originally enrolled in an earlier randomized controlled trial comparing standard treatment with standard treatment plus brief motivational interviewing for increasing adherence.
RESULTS: RESULTS indicated that, across treatment conditions, those who were female, did not have dual diagnosis, were older (older than 33 years), and were less educated (<high school) attended their first aftercare appointment at significantly higher rates than their counterparts. A treatment-by-gender interaction was noted, where only men were significantly more likely to keep their first aftercare appointment if they received standard treatment plus brief motivational interviewing, compared to standard treatment alone (OR = 9.58, p < .001).
CONCLUSIONS: Findings suggest that gender, dual diagnosis status, age and education may be an important predictors of aftercare treatment adherence and that gender may be a moderator of motivational interviewing among individuals with psychiatric disorders or dual diagnosis.

PMID: 25392061 [PubMed - indexed for MEDLINE]

A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients.

Tue, 07/07/2015 - 6:00am
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A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients.

Acad Emerg Med. 2014 Dec;21(12):1512-20

Authors: Baird J, Merchant RC

Abstract
OBJECTIVES: The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women.
METHODS: This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment.
RESULTS: A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing.
CONCLUSIONS: The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

PMID: 25491714 [PubMed - indexed for MEDLINE]

Teaching family medicine residents brief interventions for alcohol misuse.

Thu, 07/02/2015 - 6:00am
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Teaching family medicine residents brief interventions for alcohol misuse.

Int J Psychiatry Med. 2015 Jun 30;

Authors: Rule JC, Samuel P

Abstract
Across the lifespan, alcohol misuse affects a large percentage of patients seen in primary care clinics. It can lead to alcohol use disorders, ranging from risky use to alcohol dependence. Alcohol use disorders frequently complicate acute and chronic illnesses of patients seen in FM clinics. Screening patients for alcohol and substance use has become a standard of practice in most primary care settings. This report describes how a family medicine residency program solidified a residency curriculum in substance abuse screening, assessment, and brief intervention by merging three presentation-style didactics into a blended approach. The curriculum combines didactic teaching, motivational interviewing, and behavioral rehearsal of clinical practice skills. Qualitative feedback suggests that the curriculum has been successful in exposing residents to a variety of practical assessment methods and, through rehearsal, has improved resident confidence in addressing alcohol use and misuse in a primary care population.

PMID: 26130770 [PubMed - as supplied by publisher]

Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.

Wed, 06/24/2015 - 6:00am
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Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.

J Neurol Neurosurg Psychiatry. 2015 May;86(5):505-12

Authors: Kristoffersen ES, Straand J, Vetvik KG, Benth JŠ, Russell MB, Lundqvist C

Abstract
BACKGROUND: Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH.
METHODS: The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25,486 patients (age 18-50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator.
RESULTS: 42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group.
CONCLUSIONS: The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH.
TRIAL REGISTRATION NUMBER: NCT01314768.

PMID: 25112307 [PubMed - indexed for MEDLINE]

[Multidimensional family therapy: which influences, which specificities?].

Wed, 06/24/2015 - 6:00am
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[Multidimensional family therapy: which influences, which specificities?].

Encephale. 2014 Oct;40(5):408-15

Authors: Bonnaire C, Bastard N, Couteron JP, Har A, Phan O

Abstract
BACKGROUND: Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy.
OBJECTIVE: The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method.
DISCUSSION: The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision).
CONCLUSION: Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.

PMID: 23993339 [PubMed - indexed for MEDLINE]

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