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Implementing outside the box: Community-based social service provider experiences with using an alcohol screening and intervention.

Tue, 03/24/2015 - 6:00am

Implementing outside the box: Community-based social service provider experiences with using an alcohol screening and intervention.

J Soc Serv Res. 2015;41(2):233-245

Authors: Patterson Silver Wolf Adelv Unegv Waya DA, Ramsey AT, van den Berk-Clark C

Abstract
OBJECTIVE: The aim of this study is better understand perceptions of front-line social service workers who are not addiction specialists, but have to address addiction-related issues during their standard services.
METHOD: Six social service organizations implemented a validated alcohol assessment and brief education intervention. After a 3-month trial implementation period, a convenience sample of 64 front-line providers participated in six focus groups to examine barriers and facilitators to the implementation of an alcohol screening and brief intervention.
RESULTS: Three themes emerged: (1) usefulness of the intervention, (2) intervention being an appropriate fit with the agency and client population, and (3) worker commitment and proper utilization during the implementation process.
CONCLUSIONS: A cross-cutting theme that emerged was the context in which the intervention was implemented, as this was central to each of the three primary themes identified from the focus groups (i.e., the usefulness and appropriateness of the intervention and the implementation process overall). Practitioner buy-in concerns also indicate the need for better addiction service training opportunities for those without addiction-specific educational backgrounds. Future research should assess whether targeted trainings increase addiction screening and education in social services settings.

PMID: 25798019 [PubMed - as supplied by publisher]

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

Fri, 03/20/2015 - 6:00am

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

Alcohol Alcohol. 2015 Mar 18;

Authors: Bendtsen P, Anderson P, Wojnar M, Newbury-Birch D, Müssener U, Colom J, Karlsson N, Brzózka K, Spak F, Deluca P, Drummond C, Kaner E, Kłoda K, Mierzecki A, Okulicz-Kozaryn K, Parkinson K, Reynolds J, Ronda G, Segura L, Palacio J, Baena B, Slodownik L, van Steenkiste B, Wolstenholme A, Wallace P, Keurhorst MN, Laurant MG, Gual A

Abstract
AIMS: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals.
METHODS: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment.
RESULTS: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%.
CONCLUSION: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

PMID: 25787012 [PubMed - as supplied by publisher]

Screening, Brief Intervention and Referral to Treatment for Adolescents: Attitudes, Perceptions and Practice of New York School-Based Health Center Providers.

Tue, 03/17/2015 - 6:00am

Screening, Brief Intervention and Referral to Treatment for Adolescents: Attitudes, Perceptions and Practice of New York School-Based Health Center Providers.

Subst Abus. 2015 Mar 16;:0

Authors: Harris BR, Shaw BA, Sherman BR, Lawson HA

Abstract
BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been endorsed by the American Academy of Pediatrics as an evidence-based strategy to address risky substance use among adolescents in primary care. However, less than half of pediatricians even screen adolescents for substance use. The purpose of this study was to identify variation in SBIRT practice and explore how program directors' and clinicians' attitudes and perceptions of effectiveness, role responsibility, and self-efficacy impact SBIRT adoption, implementation, and practice in school-based health centers (SBHCs).
METHODS: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June 2013 (40% response rate).
RESULTS: Only 22% of participants reported practicing the SBIRT model. Of the individual SBIRT model components, using a standardized tool to screen students for risky substance use, referring students with substance use problems to specialty treatment, and assessing students' readiness to change were practiced least frequently. Less than 30% of participants felt they could be effective at helping students reduce substance use, 63% did not believe it was their role to use a standardized screening tool, and 20-30% did not feel confident performing specific aspects of intervention and management. Each of these factors was correlated with SBIRT practice frequency (p<.05).
CONCLUSIONS: Findings from this study identify an important gap between an evidence-based SBIRT model and its adoption into practice within SBHCs, indicating a need for dissemination strategies targeting role responsibility, self-efficacy, and clinician perceptions of SBIRT effectiveness.

PMID: 25774987 [PubMed - as supplied by publisher]

The Role of Schools in Substance Use Prevention and Intervention.

Tue, 03/17/2015 - 6:00am

The Role of Schools in Substance Use Prevention and Intervention.

Child Adolesc Psychiatr Clin N Am. 2015 Apr;24(2):291-303

Authors: Benningfield MM, Riggs P, Stephan SH

Abstract
Schools provide an ideal setting for screening, brief interventions, and outpatient treatment for substance use disorders (SUD). Individual treatment for SUD is effective at decreasing substance use as well as substance-related harm. In some contexts, rather than being helpful, group interventions can result in harm to participants; therefore, individual treatment may be preferred. Early interventions for adolescents who are using alcohol and other drugs (AOD) are generally effective in decreasing frequency and quantity of AOD use as well as decreasing risky behaviors.

PMID: 25773325 [PubMed - as supplied by publisher]

Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours?

Wed, 03/04/2015 - 6:00am

Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours?

Alcohol Alcohol. 2015 Mar 1;

Authors: Ward CL, Mertens JR, Bresick GF, Little F, Weisner CM

Abstract
PURPOSE: To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours.
METHODS: Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up.
RESULTS: Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours.
CONCLUSIONS: Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction.

PMID: 25731180 [PubMed - as supplied by publisher]

Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

Thu, 02/26/2015 - 6:00am

Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

J Psychoactive Drugs. 2015 January-March;47(1):1-9

Authors: Richmond MK, Pampel FC, Rivera LS, Broderick KB, Reimann B, Fischer L

Abstract
With increasing use of state legalized medical marijuana across the country, health care providers need accurate information on patterns of marijuana and other substance use for patients with access to medical marijuana. This study compared frequency and severity of marijuana use, and use of other substances, for patients with and without state legal access to medical marijuana. Data were collected from 2,030 patients who screened positive for marijuana use when seeking health care services in a large, urban safety-net medical center. Patients were screened as part of a federally funded screening, brief intervention, and referral to treatment (SBIRT) initiative. Patients were asked at screening whether they had a state-issued medical marijuana card and about risky use of tobacco, alcohol, and other illicit substances. A total of 17.4% of marijuana users had a medical marijuana card. Patients with cards had higher frequency of marijuana use and were more likely to screen at moderate than low or high risk from marijuana use. Patients with cards also had lower use of other substances than patients without cards. Findings can inform health care providers of both the specific risks of frequent, long-term use and the more limited risks of other substance use faced by legal medical marijuana users.

PMID: 25715066 [PubMed - as supplied by publisher]

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

Wed, 02/18/2015 - 6:00am
Related Articles

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

Am J Emerg Med. 2015 Jan;33(1):37-42

Authors: Akin J, Johnson JA, Seale JP, Kuperminc GP

Abstract
OBJECTIVE: The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery.
METHODS: Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods.
RESULTS: Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods.
CONCLUSIONS: When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability.

PMID: 25455051 [PubMed - indexed for MEDLINE]

Reducing substance involvement in college students: A three-arm parallel-group randomized controlled trial of a computer-based intervention.

Sat, 02/14/2015 - 6:00am

Reducing substance involvement in college students: A three-arm parallel-group randomized controlled trial of a computer-based intervention.

Addict Behav. 2015 Jan 21;45C:164-171

Authors: Christoff AO, Boerngen-Lacerda R

Abstract
The prevalence of alcohol and other drug use is high among college students. Reducing their consumption will likely be beneficial for society as a whole. Computer and web-based interventions are promising for providing behaviorally based information. The present study compared the efficacy of three interventions (computerized screening and motivational intervention [ASSIST/MBIc], non-computerized screening and motivational intervention [ASSIST/MBIi], and screening only [control]) in college students in Curitiba, Brazil. A convenience sample of 458 students scored moderate and high risk on the ASSIST. They were then randomized into the three arms of the randomized controlled trial (ASSIST/MBIc, ASSIST/MBIi [interview], and assessment-only [control]) and assessed at baseline and 3months later. The ASSIST involvement scores decreased at follow-up compared with baseline in the three groups, suggesting that any intervention is better than no intervention. For alcohol, the specific involvement scores decreased to a low level of risk in the three groups and the MBIc group showed a positive outcome compared with control, and the scores for each question were reduced in the two intervention groups compared to baseline. For tobacco, involvement scores decreased in the three groups, but they maintained moderate risk. For marijuana, a small positive effect was observed in the ASSIST/MBIi and control groups. The ASSIST/MBIc may be a good alternative to interview interventions because it is easy to administer, students frequently use such computer-based technologies, and individually tailored content can be delivered in the absence of a counselor.

PMID: 25679364 [PubMed - as supplied by publisher]

Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) into an Abortion Clinic: An Exploratory Study of Acceptability.

Sun, 01/18/2015 - 6:00am

Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) into an Abortion Clinic: An Exploratory Study of Acceptability.

Contraception. 2015 Jan 14;

Authors: Appel L, Ramanadhan S, Hladky K, Welsh C, Terplan M

Abstract
Screening, Brief Intervention, and Referral to treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6 respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use.

PMID: 25596511 [PubMed - as supplied by publisher]

Symptom severity, social supports, coping styles, and quality of life among individuals' diagnosed with Ménierè's disease.

Sun, 01/18/2015 - 6:00am

Symptom severity, social supports, coping styles, and quality of life among individuals' diagnosed with Ménierè's disease.

Chronic Illn. 2015 Jan 16;

Authors: Porter M, Boothroyd RA

Abstract
OBJECTIVES: To (1) examine the quality of life of individuals with Ménierè's disease in relation to symptom severity, social supports, and coping styles and (2) develop a prediction model to identify factors most strongly associated with quality of life.
METHODS: Data were collected using a web-based survey that included previously developed and validated measures (i.e. SF-12, Dizziness Handicap Inventory, Hearing Handicap Inventory for Elderly Screening Version, Iowa Tinnitus Handicap Questionnaire, Interpersonal Support Evaluation List, Brief COPES, Lehman's Quality of Life). Ninety-five individuals with Ménierè's disease who were members of one of five online Ménierè's disease support groups responded to the survey.
RESULTS: The findings indicated that symptom severity was negatively associated with patients' quality of life, social supports were positively associated with quality of life, and the use of negative coping styles (e.g. substance use, blaming) was negatively associated with quality of life. Four predictors (i.e. SF-12 mental health, dizziness severity, self-esteem support, and negative coping styles) accounted for 62% of the variance in quality of life.
DISCUSSION: The findings suggest that the factors associated with the quality of life of patients with Ménierè's disease are similar to those reported in the literature among patients with other chronic illnesses. The results also suggested that emphasis on psychosocial factors may be an important aspect of a comprehensive treatment intervention for individuals with Ménierè's disease.

PMID: 25595277 [PubMed - as supplied by publisher]

The implementation of an integrated information system for substance use screening in general medical settings.

Fri, 01/16/2015 - 6:00am

The implementation of an integrated information system for substance use screening in general medical settings.

Appl Clin Inform. 2014;5(4):878-94

Authors: Shanahan CW, Sorensen-Alawad A, Carney BL, Persand I, Cruz A, Botticelli M, Pressman K, Adams WG, Brolin M, Alford DP

Abstract
UNLABELLED: The Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT) Program, a substance use screening program in general medical settings, created a web-based, point-of-care (POC), application - the MASBIRT Portal (the "Portal") to meet program goals.
OBJECTIVES: We report on development and implementation of the Portal.
METHODS: Five year program process outcomes recorded by an independent evaluator and an anonymous survey of Health Educator's (HEs) adoption, perceptions and Portal use with a modified version of the Technology Readiness Index are described. [8] Specific management team members, selected based on their roles in program leadership, development and implementation of the Portal and supervision of HEs, participated in semi-structured, qualitative interviews.
RESULTS: At the conclusion of the program 73% (24/33) of the HEs completed a survey on their experience using the Portal. HEs reported that the Portal made recording screening information easy (96%); improved planning their workday (83%); facilitated POC data collection (84%); decreased time dedicated to data entry (100%); and improved job satisfaction (59%). The top two barriers to use were "no or limited wireless connectivity" (46%) and "the tablet was too heavy/bulky to carry" (29%). Qualitative management team interviews identified strategies for successful HIT implementation: importance of engaging HEs in outlining specifications and workflow needs, collaborative testing prior to implementation and clear agreement on data collection purpose, quality requirements and staff roles.
DISCUSSION: Overall, HEs perceived the Portal favorably with regard to time saving ability and improved workflow. Lessons learned included identifying core requirements early during system development and need for managers to institute and enforce consistent behavioral work norms.
CONCLUSION: Barriers and HEs' views of technology impacted the utilization of the MASBIRT Portal. Further research is needed to determine best approaches for HIT system implementation in general medical settings.

PMID: 25589904 [PubMed - in process]

South Texas Residency SBIRT Training: 12-Month Outcomes.

Tue, 01/13/2015 - 6:00am

South Texas Residency SBIRT Training: 12-Month Outcomes.

Subst Abus. 2015 Jan 12;:0

Authors: Malone GP, Vale S, Schneegans S, Amodei N, Burge SK, Wathen PI, Conde MV, Palmer R, Williams JF

Abstract
ABSTRACT Background: Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and cost-effective skill set when implemented in primary care settings regarding hazardous alcohol use. This study assesses the impact of medical resident SBIRT training across three specialties, and identifies predictors of change in trainee behavior, attitudes and knowledge over 12 months. Methods: Our program's substance use SBIRT training was developed and tailored to fit diverse curricular objectives and settings across an array of medical residency programs in South Texas. The 329 residents training in Pediatrics, Family Medicine and Internal Medicine during 2009-2012 comprised the trainee group reported in this analysis. Surveys assessing SBIRT-related knowledge, current practice, confidence, role responsibility, attitudes, beliefs, and readiness to change were completed by 234 (71%) trainees at three time points: pre-training, then 30-days and 12-months post-initial training. Results: SBIRT-related knowledge, confidence, and practice increased from pre-training to 12-months follow-up. Residents who reported the least amount of pre-training clinical and/or prior academic exposure to substance use reported the greatest SBIRT practice increases. When controlling for demographic and prior exposure variables, the largest contributor to variance in SBIRT practice was attributed to residents' confidence in their SBIRT skills. Conclusions: SBIRT training that employs diverse educational methodologies as part of customizing the training to residency specialties can similarly enhance SBIRT-related knowledge, confidence and practice. Trainee report of limited prior clinical or academic exposure to substance use and/or low confidence regarding SBIRT skills and their professional role responsibilities related to substance use predicted trainee success and sustained SBIRT strategy application. When customizing SBIRT training, curriculum developers should consider leveraging and capacity building related to those factors predicting continued use of SBIRT practices.

PMID: 25581553 [PubMed - as supplied by publisher]

Identifying and Intervening with Substance-Using Women Exposed to Intimate Partner Violence: Phenomenology, Comorbidities, and Integrated Approaches Within Primary Care and Other Agency Settings.

Sat, 01/03/2015 - 6:00am

Identifying and Intervening with Substance-Using Women Exposed to Intimate Partner Violence: Phenomenology, Comorbidities, and Integrated Approaches Within Primary Care and Other Agency Settings.

J Womens Health (Larchmt). 2015 Jan 2;

Authors: Weaver TL, Gilbert L, El-Bassel N, Resnick HS, Noursi S

Abstract
Abstract Substance use and/or disorders (SUDs) have been identified as a significant correlate of intimate partner violence (IPV) exposure and present complex issues that intersect with the topography of IPV, attendant mental health, and physical co-morbidities and may pose barriers to primary care- and other agency-based screening and intervention efforts. Despite substantial research indicating significantly higher rates of all types and severity of IPV victimization among women with SUDs and bidirectional associations between partner or self-use of drugs or alcohol and IPV victimization, effective screening, brief interventions, coordinated systems of care, and treatment approaches to address these co-occurring problems remain very limited. We integrated select research examining the intersection of IPV victimization and SUDs and several comorbidities that have significant public health impact and provided recommendations for scaling up targeted interventions to redress these co-occurring problems among women in primary, emergency, and other care settings.

PMID: 25554915 [PubMed - as supplied by publisher]

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

Fri, 01/02/2015 - 6:00am

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 - as supplied by publisher]

A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation.

Wed, 12/24/2014 - 6:00am

A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation.

Health Serv Res. 2014 Dec 23;

Authors: Rieckmann T, Abraham A, Zwick J, Rasplica C, McCarty D

Abstract
OBJECTIVE: To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT).
DATA SOURCES/STUDY SETTING: Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009.
STUDY DESIGN/DATA COLLECTION: The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs.
PRINCIPAL FINDINGS: Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged.
CONCLUSIONS: Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.

PMID: 25532616 [PubMed - as supplied by publisher]

Community-based HCV screening: knowledge and attitudes in a high risk urban population.

Fri, 12/19/2014 - 6:00am
Related Articles

Community-based HCV screening: knowledge and attitudes in a high risk urban population.

BMC Infect Dis. 2014;14:74

Authors: Norton BL, Voils CI, Timberlake SH, Hecker EJ, Goswami ND, Huffman KM, Landgraf A, Naggie S, Stout JE

Abstract
BACKGROUND: In an attempt to curtail the rising morbidity and mortality from undiagnosed HCV (hepatitis C virus) in the United States, screening guidelines have been expanded to high-risk individuals and persons born 1945-1965. Community-based screening may be one strategy in which to reach such persons; however, the acceptance of HCV testing, when many high-risk individuals may not have access to HCV specific medications, remains unknown.
METHODS: We set out to assess attitudes about HCV screening and knowledge about HCV disease at several community-based testing sites that serve high-risk populations. This assessment was paired with a brief HCV educational intervention, followed by post-education evaluation.
RESULTS: Participants (n = 140) were surveyed at five sites; two homeless shelters, two drug rehabilitation centers, and a women's "drop-in" center. Personal acceptance of HCV testing was almost unanimous, and 90% of participants reported that they would still want to be tested even if they were unable to receive HCV treatment. Baseline hepatitis C knowledge was poor; however, the brief educational intervention significantly improved knowledge and increased acceptability of testing when medical access issues were explicitly stated.
CONCLUSIONS: Despite inconsistencies in access to care and treatment, high-risk communities want to know their HCV status. Though baseline HCV knowledge was poor in this population, a brief on-site educational intervention improved both knowledge and acceptability of HCV testing and care. These data support the establishment of programs that utilize community-based screening, and also provide initial evidence for acceptance of the implementation of the recently expanded screening guidelines among marginalized communities.

PMID: 24512462 [PubMed - indexed for MEDLINE]

Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings.

Thu, 12/18/2014 - 6:00am

Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings.

J Subst Abuse Treat. 2014 Nov 5;

Authors: Dunn C, Darnell D, Carmel A, Atkins DC, Bumgardner K, Roy-Byrne P

Abstract
This quasi experimental study compared the motivational interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 audiorecorded BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40months post MI training. Both groups met the lower standard (beginning proficiency in MI) on 4 of 5 MI integrity scores, but NRCPs met more of the higher standards (competency in MI) than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity.

PMID: 25515624 [PubMed - as supplied by publisher]

[The addiction patient in the family physicians' practice: tools and skills for a successful performance].

Wed, 12/17/2014 - 6:00am
Related Articles

[The addiction patient in the family physicians' practice: tools and skills for a successful performance].

Ther Umsch. 2014 Oct;71(10):585-91

Authors: Neuner-Jehle S

Abstract
Addiction patients are usually perceived as problematic patients in primary care practices: Encounters often are time-consuming and the approach to the patient is difficult. Moreover, patients sometimes are hiding their addictive behaviour and behave shameful. Other barriers are a lack of experience in communication skills among physicians or their own addictive behaviour. Nevertheless, to diagnose and treat addiction as early as possible is an important task for family doctors, as patients' confidence in them is an important factor to induce a behaviour change. We present four screening tests for the early diagnosis of addiction to alcohol (AUDIT, AUDIT-C, CAGE, SMAST-G) and discuss their strengths and shortcomings. The family doctor's practice is also a useful setting for brief interventions based on motivational interviewing (MI) techniques and the transtheoretical model of behaviour change (TTM). We shortly introduce to these techniques and attitudes using addiction to alcohol and nicotine as examples, and we present innovative methods as "defined drinking" and new quit smoking methods. A respectful attitude towards the patient and communication skills seem to be key factors for family physicians to successfully approach their addiction patients.

PMID: 25257112 [PubMed - indexed for MEDLINE]

SBIRT goes to college: interdisciplinary screening for alcohol use.

Mon, 12/15/2014 - 1:30pm
Related Articles

SBIRT goes to college: interdisciplinary screening for alcohol use.

J Addict Nurs. 2013 Jan-Mar;24(1):45-50

Authors: Naegle M, Himmel J, Ellis P

Abstract
Although risky/harmful drinking, in the form of binge drinking, remains a national problem, only recently have health services in universities systematically screened for drinking, drug use, and smoking. This article recounts "lessons learned" in two nurse-directed, interdisciplinary health services, which adapted the National College Depression Partnership model to include screening and brief intervention (SBIRT) for risky/harmful alcohol use in the form of binge drinking. Using a planned change model, nurse leaders worked with university administrators, providers, and health service staff to screen all students seeking health services for risky drinking. The outcomes suggest that this process may increase staff and student awareness of the importance of alcohol consumption to health, show the ease of using SBIRT screening along with standard screening tools, and yield information on the normalization of high-risk drinking in collegiate settings. Project findings indicate that common perceptions in college students minimize negative outcomes and stress the importance of additional quality assurance initiatives that review the efficacy of combinations of standardized screening tools.

PMID: 24622529 [PubMed - indexed for MEDLINE]

Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.

Mon, 12/15/2014 - 1:30pm
Related Articles

Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.

J Addict Nurs. 2013 Jan-Mar;24(1):8-19

Authors: Broyles LM, Gordon AJ, Rodriguez KL, Hanusa BH, Kengor C, Kraemer KL

Abstract
Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.

PMID: 24622525 [PubMed - indexed for MEDLINE]

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