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Reducing Risky Alcohol Use: What Health Care Systems Can Do.

Thu, 12/08/2016 - 4:29pm
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Reducing Risky Alcohol Use: What Health Care Systems Can Do.

Issue Brief (Mass Health Policy Forum). 2016 Apr 27;(46):1-50

Authors: Quinn AE, Brolin M, Stewart MT, Evans B, Horgan C

Abstract
Risky, non-dependent alcohol use is prevalent in the United States, affecting 25% of adults (Centers for Disease Control and Prevention, 2014b). Massachusetts has higher rates of alcohol use and binge drinking than most states (Substance Abuse and Mental Health Services Administration, 2015). Serious physical, social, and economic consequences result. Excessive alcohol use contributes to cancer, cardiovascular disease, sleep disorders, birth defects, motor vehicle injuries, and suicide, and it complicates management of chronic illnesses (Green, McKnight-Eily, Tan, Mejia, & Denny, 2016; Laramee et al., 2015; Mokdad, Marks, Stroup, & Gerberding, 2004; Rehm et al., 2009). Excessive alcohol use is one of the top causes of death, and over 240 alcohol-related deaths occur daily in the US (Mokdad et al., 2004; Stahre, Roeber, Kanny, Brewer, & Zhang, 2014). In comparison, 78 people die from an opioid overdose each day (Centers for Disease Control and Prevention, 2016). Excessive drinking is estimated to cost over $249 billion annually in the US and $5.6 billion in the Commonwealth (Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015). This issue brief describes the scope of the risky drinking problem in the US and associated costs and consequences. The brief then examines the evidence base for tools to address risky drinking and outlines policy strategies that health care system stakeholders may employ to address further this critical public health issue. Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address risky alcohol use, typically using a short validated screening tool followed by a brief counseling session if a patient screens positive. Research shows SBI conducted in primary care outpatient settings significantly reduces alcohol use (Bertholet, Daeppen, Wietlisbach, Fleming, & Burnand, 2005b; Bien, Miller, & Tonigan, 1993; Kaner et al., 2009; Saitz, 2010a), hospitalizations (Fleming, Barry, Manwell, Johnson, & London, 1997b) and mortality (Cuijpers, Riper, & Lemmers, 2004). Alcohol SBI saves an estimated $217.95 per person screened (Barbosa, Cowell, Bray, & Aldridge, 2015).

PMID: 27911073 [PubMed - in process]

Brief Report: A Randomized Control Trial Assessing the Influence of a Telephone-based Intervention on Readmissions for Patients with Severe Mental Illness in a Developing Country.

Thu, 12/08/2016 - 4:29pm
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Brief Report: A Randomized Control Trial Assessing the Influence of a Telephone-based Intervention on Readmissions for Patients with Severe Mental Illness in a Developing Country.

Community Ment Health J. 2016 Nov 30;

Authors: Botha UA, Koen L, Mazinu M, Jordaan E, Niehaus DJ

Abstract
Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were randomized to facilitated care or treatment as usual. All were interviewed prior to discharge and after 12 months. Facilitated care consisted of structured telephonic interviews and motivational support to patients and families. At 12 months no significant differences in either readmissions (p = 0.10) or days in hospital (p = 0.44) could be demonstrated. Substance use was high (64%), particularly methamphetamine (44%) in both groups. The intervention did not have any impact on inpatient usage in our setting. Though this study was limited by its small sample size, the results indicated that affordable post-discharge services may not be comprehensive enough to reduce readmission rates and would have to be tailored to the distinct population of dual diagnosis patients identified in this study.

PMID: 27900649 [PubMed - as supplied by publisher]

Faculty Development Efforts to Promote Screening, Brief Intervention and Referral to Treatment (SBIRT) in an Internal Medicine Faculty-Resident Practice.

Thu, 12/01/2016 - 4:29pm

Faculty Development Efforts to Promote Screening, Brief Intervention and Referral to Treatment (SBIRT) in an Internal Medicine Faculty-Resident Practice.

Subst Abus. 2016 Nov 29;:0

Authors: Stone A, Wamsley M, O'Sullivan P, Satterfield J, Satre DD, Julian K

Abstract
BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is a practical means to address substance misuse in primary care. Important barriers to implementing SBIRT include adequacy of training and provider confidence as well as logistical hurdles and time constraints. A faculty development initiative aimed at increasing SBIRT knowledge and treatment of substance use disorders (SUDs) should lead to increased use of SBIRT by faculty and the residents they teach. This study examined how a faculty development program to promote SBIRT influenced faculty practice and resident teaching.
METHODS: This was a cross-sectional study of faculty exposed to multiple SBIRT educational interventions over a five-year period in an academic resident-faculty general medicine practice. Participants completed a brief online survey followed by a semi-structured interview. Quantitative responses were examined descriptively. Qualitative questions were reviewed to identify key themes.
RESULTS: Fifteen of 29 faculty (52%) completed the survey and 13 (45%) completed the interviews regarding faculty development interventions. Faculty thought that SBIRT was an important skill and had confidence in screening for substance use disorders, though confidence in making treatment referrals and prescribing pharmacotherapy were rated lower. Many faculty reported screening more frequently for SUDs after attending faculty development sessions. However, several reported that the training did not improve their SBIRT teaching to residents during clinic precepting sessions. To improve uptake of SBIRT, a majority of faculty recommended electronic health record (EHR) alerts.
CONCLUSIONS: SBIRT is a highly valued set of skills and training may enhance rates of screening for substance misuse. However, participants did not report a substantial change in SBIRT teaching as a result of faculty development. In the future, small targeted faculty development sessions, potentially involving strategies for using the EHR, may be an effective way to enhance primary care SBIRT skills.

PMID: 27897470 [PubMed - as supplied by publisher]

SBIRT-Based Interventions to Improve Pediatric Oral Health Behaviors and Outcomes: Considerations for Future Behavioral SBIRT Interventions in Dentistry.

Thu, 11/24/2016 - 4:29pm
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SBIRT-Based Interventions to Improve Pediatric Oral Health Behaviors and Outcomes: Considerations for Future Behavioral SBIRT Interventions in Dentistry.

Curr Oral Health Rep. 2016 Sep;3(3):187-192

Authors: Cuevas J, Chi DL

Abstract
Dental caries is the most common chronic disease in children and is caused by poor oral health behaviors. These behaviors include high-sugar diet, inadequate exposure to topical fluorides, and irregular use of professional dental care services. A number of behavioral intervention approaches have been used to modify health behaviors. One example is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has been widely used to reduce substance abuse in both adults and children. SBIRT is a promising behavior change approach that could similarly be used to address problematic oral health behaviors. In this paper, we will review oral health studies that have adopted SBIRT components, assess if these interventions improved oral health behaviors and outcomes, and outline considerations for researchers interested in developing and testing future oral health-related SBIRT interventions in dentistry.

PMID: 27857880 [PubMed - in process]

[Barriers to implementing screening, brief intervention and referral to treatment for substance use in HIV/AIDS health services in Peru].

Thu, 11/17/2016 - 4:28pm
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[Barriers to implementing screening, brief intervention and referral to treatment for substance use in HIV/AIDS health services in Peru].

Rev Peru Med Exp Salud Publica. 2016 Jul-Sep;33(3):432-437

Authors: Hoffman KA, Beltrán J, Ponce J, García-Fernandez L, Calderón M, Muench J, Benites C, Soto L, McCarty D, Fiestas F

Abstract
Objectives.: Screening and treatment for substance use among people living with HIV/AIDS (PLWHA) is highly recommended. Nevertheless, in Peru healthcare for PLWHA does not include a standardized or systematic assessment to identify substance use. The aim of this study was to assess the feasibility of implementing screening, brief intervention and referral to treatment (SBIRT) in healthcare settings attending people living with PLWHA.
Materials and methods.: After providing training in SBIRT for PLWHA's healthcare personnel (including nurses and physicians) focus groups were conducted to explore knowledge, beliefs and perceived barriers to implementation and interviews were conducted to assess the barriers and facilitators of two tertiary hospitals in Lima, Peru.
Results.: focus groups and interviews' thematic coding revealed three dimensions: 1) the unknown extent of substance use within PLWHA, 2) space and time limitations hinder completion of brief interventions during routine visits, and 3) insufficient access to substance use treatment appropriate for HIV patients.
Conclusions.: Multiple barriers, including lack of awareness of substance use problems, limited space and time of providers, and lack of specialized services to refer patients for treatment make it difficult to implement SBIRT in the Peruvian healthcare system.

PMID: 27831605 [PubMed - in process]

Examining the efficacy of a computer facilitated HIV prevention tool in drug court.

Thu, 11/17/2016 - 4:28pm
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Examining the efficacy of a computer facilitated HIV prevention tool in drug court.

Drug Alcohol Depend. 2016 May 1;162:44-50

Authors: Festinger DS, Dugosh KL, Kurth AE, Metzger DS

Abstract
BACKGROUND: Although they have demonstrated efficacy in reducing substance use and criminal recidivism, competing priorities and limited resources may preclude drug court programs from formally addressing HIV risk. This study examined the efficacy of a brief, three-session, computer-facilitated HIV prevention intervention in reducing HIV risk among adult felony drug court participants.
METHODS: Two hundred participants were randomly assigned to an HIV intervention (n=101) or attention control (n=99) group. All clients attended judicial status hearings approximately every six weeks. At the first three status hearings following study entry, clients in the intervention group completed the computerized, interactive HIV risk reduction sessions while those in the control group viewed a series of educational life-skill videos of matched length. Outcomes included the rate of independently obtained HIV testing, engagement in high risk HIV-related behaviors, and rate of condom procurement from the research site at each session.
RESULTS: Results indicated that participants who received the HIV intervention were significantly more likely to report having obtained HIV testing at some point during the study period than those in the control condition, although the effect was marginally significant when examined in a longitudinal model. In addition, they had higher rates of condom procurement. No group differences were found on rates of high-risk sexual behavior, and the low rate of injection drug reported precluded examination of high-risk drug-related behavior.
CONCLUSIONS: The study provides support for the feasibility and utility of delivering HIV prevention services to drug court clients using an efficient computer-facilitated program.

PMID: 26971228 [PubMed - indexed for MEDLINE]

Tailoring a brief intervention for illicit drug use and alcohol use in Irish methadone maintained opiate dependent patients: a qualitative process.

Thu, 11/10/2016 - 4:12pm
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Tailoring a brief intervention for illicit drug use and alcohol use in Irish methadone maintained opiate dependent patients: a qualitative process.

BMC Psychiatry. 2016 Nov 3;16(1):373

Authors: Darker C, Sweeney B, Keenan E, Whiston L, Anderson R, Barry J

Abstract
BACKGROUND: The World Health Organization (WHO) recommend the tailoring of a brief intervention (BI) programme of research to ensure that it is both culturally and contextually appropriate for the country and the environment in which it is being tested. The majority of BI research has been conducted with non-opioid dependent participants. The current study developed a tailored BI for illicit drug use and alcohol use to a methadone maintained opioid dependent polydrug using cohort of patients.
METHODS: Focus groups with staff and one-to-one qualitative interviews with patients guided the tailoring of all intervention materials for use in a subsequent cluster randomised controlled trial (RCT). This was done to make them contextually appropriate to an opioid dependent cohort and culturally appropriate to Ireland. Thematic analyses were utilised.
RESULTS: The BI was modified to ensure its compatibility with the culture of an Irish drug using population, with elements of motivational interviewing (MI) and personalised feedback incorporated. Example scripts of a screening and BI were included, as was an algorithm to facilitate clinicians during a session. Modifications to the 'Substance Use Risk' cards included weighting the severity of the problems, writing the language in the first person to personalise the feedback and including tick boxes so as to further highlight the relevant risk factors for individual patients. Photographs of key risk factors were included to display pictorially risks for illiterate or semi-literate patients. Examples of the interaction of particular substances with methadone were of particular importance to this group. Modifications of the 'Pros and Cons of Substance Use/Reasons to Quit or Cut Down' included additional categories such as addiction, crime and money that were salient to this cohort. The manual was used to standardise training across trial sites.
CONCLUSION: The research team was faithful to WHO recommendations to tailor BI programmes that are culturally and contextually appropriate to the treatment cohort and clinical environment. Outcome data from the cluster RCT have demonstrated that the tailored intervention was effective.

PMID: 27809831 [PubMed - in process]

Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy.

Thu, 11/10/2016 - 4:12pm
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Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy.

Sex Reprod Healthc. 2015 Oct;6(3):186-90

Authors: Wangberg SC

Abstract
OBJECTIVE: This study assessed the current screening for and brief intervention (BI) on alcohol use in pregnancy among midwives in Norway, as well as perceived barriers for such practice.
DESIGN, SETTING AND PARTICIPANTS: An Internet and telephone survey was conducted among all 200 registered municipal midwives in the Norwegian health regions North, West and South in the period December 2013-May 2014. Of these, 103 midwives were reached and responded (52%).
MEASUREMENT AND FINDINGS: Most of the midwives (97%) asked the pregnant women about their alcohol use at their first consultation. 42% of the midwives reported using a screening instrument. When asked which one, AUDIT or TWEAK was mentioned by 16%. The need for more training in screening tools was reported by 66%. Sixty-four percent of midwives working in municipalities that had received special training compared with 50% among the rest said that they intervened themselves if alcohol use was detected (χ(2) = 0.32, P = .645). Motivational Interviewing was well known and frequently used. Low perceived BI competence and finding it difficult to discuss alcohol use with parents with a different ethnicity both reduced chances of carrying out a BI. Time constraints and lack of organizational support were other frequently mentioned barriers.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It seems that the Norwegian midwives find screening and brief interventions for alcohol use to be important and part of their job, but still could use more training, stronger guidelines and more time for following up parents.

PMID: 26842644 [PubMed - indexed for MEDLINE]

The role of screening, brief intervention, and referral to treatment in the perinatal period.

Thu, 11/03/2016 - 5:12pm
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The role of screening, brief intervention, and referral to treatment in the perinatal period.

Am J Obstet Gynecol. 2016 Nov;215(5):539-547

Authors: Wright TE, Terplan M, Ondersma SJ, Boyce C, Yonkers K, Chang G, Creanga AA

Abstract
Substance use during pregnancy is at least as common as many of the medical conditions screened for and managed during pregnancy. While harmful and costly, it is often ignored or managed poorly. Screening, brief intervention, and referral to treatment is an evidence-based approach to manage substance use. In September 2012, the US Centers for Disease Control and Prevention convened an Expert Meeting on Perinatal Illicit Drug Abuse to help address key issues around drug use in pregnancy in the United States. This article reflects the formal conclusions of the expert panel that discussed the use of screening, brief intervention, and referral to treatment during pregnancy. Screening for substance use during pregnancy should be universal. It allows stratification of women into zones of risk given their pattern of use. Low-risk women should receive brief advice, those classified as moderate risk should receive a brief intervention, whereas those who are high risk need referral to specialty care. A brief intervention is a patient-centered form of counseling using the principles of motivational interviewing. Screening, brief intervention, and referral to treatment has the potential to reduce the burden of substance use in pregnancy and should be integrated into prenatal care.

PMID: 27373599 [PubMed - in process]

Incorporating screening, brief intervention, and referral to treatment into emergency nursing workflow using an existing computerized physician order entry/clinical decision support system.

Thu, 11/03/2016 - 5:12pm
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Incorporating screening, brief intervention, and referral to treatment into emergency nursing workflow using an existing computerized physician order entry/clinical decision support system.

J Emerg Nurs. 2014 Nov;40(6):568-74

Authors: Slain T, Rickard-Aasen S, Pringle JL, Hegde GG, Shang J, Johnjulio W, Venkat A

Abstract
INTRODUCTION: The objective of this study was to evaluate whether screening, brief intervention, and referral to treatment (SBIRT) could be incorporated into the emergency nursing workflow using a computerized physician order entry/clinical decision support system. We report demographic and operational factors associated with failure to initiate the protocol and revenue collection from SBIRT.
METHODS: We conducted a retrospective, observational cohort analysis of a protocol adding SBIRT to the emergency nursing workflow of a single, tertiary care urban emergency department for all adult patient visits in 2012. Emergency nurses prescreened for unhealthy alcohol or drug use during triage assessment and, when positive, administered SBIRT during treatment area care, all documented in the computerized physician order entry/clinical decision support system. Using multivariable logistic regression, we report demographic and operational factors associated with failure to initiate the protocol. From October 2012, we submitted charges for brief interventions and analyzed collection results.
RESULTS: The inclusion criteria were met for 47,693 visits. Of these, 39,758 (83.4%) received triage protocol initiation. Variables associated with decreased odds of protocol initiation were younger age (odds ratio [OR] for rising age, 1.044; 95% confidence interval [CI], 1.042-1.045), arrival by ambulance (OR, 0.37; 95% CI, 0.35-0.40), and higher triage acuity (OR, 0.08; 95% CI, 0.07-0.09). Of visits with protocol initiation, 21.4% were documented as positive for at-risk alcohol and/or drug use. However, brief interventions were only administered during 971 visits. During the billing period, $3617.53 was collected on charges of $10,829.15 for 262 completed brief interventions.
DISCUSSION: In this study electronic documentation of adults with at-risk alcohol and/or drug use was feasible by emergency nurses, but SBIRT execution and subsequent revenue collection were challenging.

PMID: 24332380 [PubMed - indexed for MEDLINE]

Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety).

Thu, 10/27/2016 - 5:12pm
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Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety).

Drug Alcohol Rev. 2016 Oct 22;:

Authors: Gilbert L, Jiwatram-Negron T, Nikitin D, Rychkova O, McCrimmon T, Ermolaeva I, Sharonova N, Mukambetov A, Hunt T

Abstract
INTRODUCTION AND AIMS: Intimate partner violence (IPV) and other forms of gender-based violence (GBV) are serious public health threats among women who use drugs or engage in binge drinking in Kyrgyzstan. This study aimed to evaluate the feasibility and preliminary effects of a two-session IPV and GBV screening, brief intervention and referral to treatment model (WINGS) with HIV counselling and testing for women who use drugs or engage in binge drinking in Kyrgyzstan, using a pre/post-design.
DESIGN AND METHODS: We screened 109 women from harm reduction non-government organisations in Kyrgyzstan, of whom 78 were eligible, 73 participated in the intervention study, and 66 completed a 3-month post-intervention follow-up. To assess the effects of the intervention, we used random-effect Poisson and Logistic regression analyses for continuous and dichotomous outcomes respectively.
RESULTS: At baseline, 73% reported any physical or sexual IPV victimisation, and 60% reported any physical or sexual GBV victimisation in the past year. At the 3-month follow-up, participants reported experiencing 59% fewer physical IPV incidents in the prior 90 days than at baseline (P < 0.001) and 27% fewer physical GBV incidents than at baseline (P < 0.01). From baseline to the 3-month follow-up, participants also reported a 65% reduction in the odds of using any illicit drugs (P < 0.05) and were more likely to report receiving GBV-related services (P < 0.001). Discussion and conclusion The high rates of participation, attendance and retention and significant reductions in IPV and GBV victimisation and drug use from baseline to the 3-month follow-up suggest the feasibility and promising effects of this brief intervention. [Gilbert L, Jiwatram-Negron T, Nikitin D, Rychkova O, McCrimmon T, Ermolaeva I, Sharonova N, Mukambetov A, Hunt T. Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety). Drug Alcohol Rev 2016;00:000-000.].

PMID: 27770541 [PubMed - as supplied by publisher]

Developing a framework of care for opioid medication misuse in community pharmacy.

Thu, 10/27/2016 - 5:12pm
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Developing a framework of care for opioid medication misuse in community pharmacy.

Res Social Adm Pharm. 2016 Mar-Apr;12(2):293-301

Authors: Cochran G, Gordon AJ, Field C, Bacci J, Dhital R, Ylioja T, Stitzer M, Kelly T, Tarter R

Abstract
BACKGROUND: Prescription opioid misuse is a major public health concern in the US. Few resources exist to support community pharmacists engaging patients who misuse or are at risk for misuse.
OBJECTIVES: This report describes the results of the execution of the ADAPT-ITT model (a model for modifying evidence-based behavioral interventions to new populations and service settings) to guide the development of a behavioral health framework for opioid medication misuse in the community pharmacy setting.
METHODS: Pharmacy, addiction, intervention, and treatment experts were convened to attend a one-day meeting to review the empirical knowledgebase and discuss adapting the screening, brief intervention, and referral to treatment (SBIRT) protocol for addressing opioid medication misuse in community pharmacy. Qualitative data gathered from the meeting were analyzed by 2 independent coders in a 2-cycle process using objective coding schemes. Percentage of agreement and Cohen's Kappa were calculated to assess coder agreement.
RESULTS: First-cycle coding identified 4 distinct themes, with coder percentage of agreement ranging from 93.5 to 99.6% and with Kappa values between 0.81 and 0.93. Second-cycle coding identified 10 sub-themes, with coder percentage of agreement ranging from 83 to 99.8% and with Kappa values between 0.58 and 0.93. Identified themes and sub-themes encompassed patient identification, intervention, prevention, and referral to treatment.
CONCLUSIONS: Focus of screening efforts in the emerging model should capitalize on pharmacists' knowledge of medication management. Screening likewise should be multidimensional in order to facilitate patient-centered interventions that activate additional disciplines able to interface with patients at risk or involved in medication misuse.

PMID: 26048710 [PubMed - indexed for MEDLINE]

&quot;You Should Drink Less&quot;: Frequency and Predictors of Discussions Between Providers and Patients About Reducing Alcohol Use.

Thu, 10/20/2016 - 5:11pm

"You Should Drink Less": Frequency and Predictors of Discussions Between Providers and Patients About Reducing Alcohol Use.

Subst Use Misuse. 2016 Oct 18;:1-6

Authors: Farmer CM, Stahlman S, Hepner KA

Abstract
BACKGROUND: Brief intervention is recommended for individuals who misuse alcohol, but studies vary on how frequently patients talk with their providers about alcohol use.
OBJECTIVES: We examined whether veterans who had recently screened positive for alcohol misuse reported having conversations about their alcohol use with their providers.
METHODS: Following a positive screening for alcohol misuse during a primary care visit in 2013, veterans completed a telephone interview on alcohol use, conversations with their providers about drinking, and factors potentially associated with such conversations. The final analysis sample included 881 veterans; we conducted descriptive statistics and multivariable regression analyses.
RESULTS: Most veterans (83%) reported that their provider asked about drinking. Among these, 65% reported being advised to drink less, and 36% reported being advised to abstain. Veterans who received their healthcare from Veterans Health Administration (VA) had over twice the odds of reporting advice to reduce/abstain from drinking (adjusted odds ratio (AOR) = 2.34, 95% confidence interval (CI) = 1.46, 3.75). Veterans who reported heavy episodic drinking were more likely to report advice to reduce/abstain from drinking than those who did not report (AOR = 1.83, 95% CI = 1.30, 2.57) and veterans who reported heavy drinking were more likely to report such advice (AOR = 2.40, 95% CI = 1.69, 3.40). Conclusions/Importance: Most veterans with alcohol misuse reported receiving advice to reduce or abstain from drinking. Veterans with excessive alcohol use and those receiving all or most of their care from VA were more likely to report receiving such advice. Self-report of receiving advice may be an important approach to assessing appropriate follow-up after detection of alcohol misuse.

PMID: 27754801 [PubMed - as supplied by publisher]

Systematic Review of ED-based Intimate Partner Violence Intervention Research.

Thu, 10/13/2016 - 5:11pm
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Systematic Review of ED-based Intimate Partner Violence Intervention Research.

West J Emerg Med. 2015 Dec;16(7):1037-42

Authors: Choo EK, Gottlieb AS, DeLuca M, Tape C, Colwell L, Zlotnick C

Abstract
INTRODUCTION: Assessment reactivity may be a factor in the modest results of brief interventions for substance use in the emergency department (ED). The presence of assessment reactivity in studies of interventions for intimate partner violence (IPV) has not been studied. Our objectives were to identify ED IPV intervention studies and evaluate the presence of a consistently positive effect on the control groups.
METHODS: We performed a systematic search of electronic databases for English=language intervention studies addressing IPV in the ED published since 1990. Study selection and assessment of methodologic quality were performed by two independent reviewers. Data extraction was performed by one reviewer and then independently checked for completeness and accuracy by a second reviewer.
RESULTS: Of 3,620 unique manuscripts identified by database search, 667 underwent abstract review and 12 underwent full-text review. Only three met full eligibility criteria; data on the control arm were available for two studies. In these two studies, IPV-related outcomes improved for both the experimental and control condition.
CONCLUSION: The paucity of controlled trials of IPV precluded a robust evaluation for assessment reactivity. This study highlighted a critical gap in ED research on IPV.

PMID: 26759650 [PubMed - indexed for MEDLINE]

Training Family Medicine Clerkship Students in Screening, Brief Intervention, and Referral to Treatment for Substance Use Disorders: A CERA Study.

Mon, 09/26/2016 - 10:30am
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Training Family Medicine Clerkship Students in Screening, Brief Intervention, and Referral to Treatment for Substance Use Disorders: A CERA Study.

Fam Med. 2016 Sep;48(8):618-23

Authors: Carlin-Menter SM, Malouin RA, WinklerPrins V, Danzo A, Blondell RD

PMID: 27655194 [PubMed - in process]

The use of SBIRT in substance abuse screening.

Mon, 09/26/2016 - 10:30am
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The use of SBIRT in substance abuse screening.

Nurse Pract. 2016 Oct 20;41(10):1-3

Authors: Ladegast S

Abstract
There are many barriers to screening for alcohol and drug abuse. Screening, brief intervention, and referral to treatment (SBIRT) principles can be used in identifying and helping patients with substance abuse problems. This article introduces SBIRT, discusses barriers to implementation, and reviews current practice recommendations.

PMID: 27654089 [PubMed - in process]

An Examination of the Workflow Processes of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program in Health Care Settings.

Mon, 09/19/2016 - 10:08am
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An Examination of the Workflow Processes of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program in Health Care Settings.

J Subst Abuse Treat. 2016 Jan;60:21-6

Authors: Kaiser DJ, Karuntzos G

Abstract
INTRODUCTION: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a public health program used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs that has been adapted for implementation in emergency departments and ambulatory clinics nationwide.
METHODS: This study used a combination of observational, timing, and descriptive analyses from a multisite evaluation to understand the workflow processes implemented in 21 treatment settings. Direct observations of 59 SBIRT practitioners and semi-structured interviews with 170 stakeholders, program administrators, practitioners, and program evaluators provided information about workflow in different medical care settings.
RESULTS: The SBIRT workflow processes are presented at three levels: service delivery, information storage, and information sharing. Analyses suggest limited variation in the overall workflow processes across settings, although performance sites tailored the program to fit with existing clinical processes, health information technology, and patient characteristics. Strategies for successful integration include co-locating SBIRT providers in the medical care setting and integrating SBIRT data into electronic health records.
CONCLUSIONS: Provisions within the Patient Protection and Affordable Care Act of 2010 call for the integration of behavioral health and medical care services. SBIRT is being adapted in different types of medical care settings, and the workflow processes are being adapted to ensure efficient delivery, illustrating the successful integration of behavioral health and medical care.

PMID: 26381929 [PubMed - indexed for MEDLINE]

Local Implementation of Alcohol Screening and Brief Intervention at Five Veterans Health Administration Primary Care Clinics: Perspectives of Clinical and Administrative Staff.

Mon, 09/19/2016 - 10:08am
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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. 2016 Jan;60:27-35

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 - indexed for MEDLINE]

Screening, Brief Intervention, and Referral to Treatment.

Wed, 09/14/2016 - 9:47am
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Screening, Brief Intervention, and Referral to Treatment.

Child Adolesc Psychiatr Clin N Am. 2016 Oct;25(4):579-601

Authors: Borus J, Parhami I, Levy S

Abstract
Screening, Brief Intervention, and Referral to Treatment is a quick, effective technique with which to manage substance use in adolescents and young adults. Use of a validated measure for detecting substance use and abuse is significantly more effective than unvalidated tools or provider intuition. There are a variety of validated tools available to use in the adolescent/young adult population, and there are opportunities to increase the efficiency and scalability of screening by using computerized questionnaires. This area continues to evolve rapidly.

PMID: 27613340 [PubMed - in process]

Alcohol and Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Among People Living With HIV/AIDS.

Wed, 09/07/2016 - 9:47am
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Alcohol and Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Among People Living With HIV/AIDS.

J Addict Nurs. 2016 Jul-Sep;27(3):214-7

Authors: Savage CL, Sanchez M

Abstract
PURPOSE: The purpose of this review is to inform nurses on the prevalence of substance use screening with screening, brief intervention, and referral to treatment; its use in the primary care setting; and its effectiveness on HIV-related risk behaviors to prevent adverse health consequences among people living with HIV/AIDS (PLWH).
REVIEW: For PLWH, identification of at-risk substance use is important because of the association between substance use and HIV infection both in terms of acquiring HIV and in further transmission of HIV.
CONCLUSION: Alcohol and substance use disorders continue to be a burden for PLWH and are associated with poor health outcomes. Implementation of screening, brief intervention, and referral to treatment in the primary care setting is critical for promoting positive health outcomes in this population and provides an opportunity for nurses to intervene.

PMID: 27580195 [PubMed - in process]

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