SBIRT Core Training Activity: Screening, Brief Interventions, and Referral to Treatment
This activity is NY OASAS approved for Medicaid reimbursement training
|Professional Practice GapAs many as 20% of primary care patients have substance use problems and primary care physicians could have a significant impact on their problems through providing screening, brief interventions, and referral to treatment (SBIRT) (Mersy, 2003). Unfortunately, PCPs screen less than half of their patients for tobacco use and less than a third for alcohol use (Seale et al 2010, Roche & Freeman 2004). The rate of screening for illicit drug use is also inadequate; about a third of primary care physicians and psychiatrists surveyed in one study did not screen routinely for illicit drug use (Friedmann, et al., 2001). Brief intervention in primary care is effective and cost-efficient approach to reduce patients' alcohol use (AAFP 2010; Seale 2010; Madras 2009). There is growing evidence that brief intervention for illicit drug use may also lead to positive patient outcomes (Compton 2009, Volkow 2010). And evidence also supports the effectiveness of interventions by medical providers for tobacco (USPSTF, 2008). However, brief interventions happen even less often than screening; for example counseling for problem drinking without dependence was reported by only 13% of patients in the 1998 Healthcare for Communities survey (D'Amico, 2005). Appropriate follow-up is also happening less often than is optimal. For example, only a little less than 50% of problem drinkers in this study reported receiving follow-up. There is also a practice gap in referral to treatment. Less than one-third of PCPs make a referral after identifying a substance abuse problem (CASA, 2000). Primary care physicians need to understand the different types of specialty treatment so that they can make appropriate referrals for their substance abuse patients (SAMHSA, 2008).|
American Academy of Family Physicians (AAFP). Brief Alcohol Screening and Intervention in Family Medicine. 2010. Available at: http://www.aafp.org/online/en/home/clinical/publichealth/alcohol.html
Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Med Care. 2005; 43(3):229-236.
Friedmann PD, McCullough D, Saitz R. Screening and Intervention for Illicit Drug Abuse. A National Survey of Primary Care Physicians and Psychiatrists. Arch Intern Med. 2001;161(2):248-251.
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23: 11-18.
The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. 2000. Columbia University. Available at: http://www.casacolumbia.org/download.aspx?path=/UploadedFiles/kksvjhvx.pdf
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18.
Substance Abuse and Mental Health Services Administration (SAMHSA). A Guide to Substance Abuse Services for Primary Care Clinicians: Concise Desk Reference. 2008. Treatment Improvement Protocol (TIP) Series #24.
U.S. Preventive Services Task Force Grade Definitions After May 2007. May 2008. http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm
Goal/Expected Learner OutcomeThe learner will be able to appropriately screen for and identify substance abuse, plan and implement a tailored brief intervention, and will apply the SBI approach to substance abuse problems by individualizing these clinical skills to different patients. The learner will be able to improve care management and referral skills for patients with relatively more severe substance use problems and improve follow-up and brief treatment skills for patients with substance use problems. The learner will apply all SBIRT clinical skills learned in several simulated cases with a variety of substance use problems.
Participation and Technical Requirements
Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records. Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity. Technical Requirements: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.
This activity is designed to change competence, performance, and patient outcome.
To complete the activity:
Primary care providers and counselors
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Initial development of this activity was supported by a contract from the National Institute on Drug Abuse (#HHSN271200800038C).
Educational Objectives:After completing this activity, participants will be able to: