Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2021

Open Access 01-12-2021 | Research

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

Authors: Claire van der Westhuizen, Megan Malan, Tracey Naledi, Marinda Roelofse, Bronwyn Myers, Dan J. Stein, Sa’ad Lahri, Katherine Sorsdahl

Published in: Addiction Science & Clinical Practice | Issue 1/2021

Login to get access

Abstract

Background

Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs).

Methods

This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes.

Results

Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings.

Conclusions

This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.
Literature
1.
Barata IA, Shandro JR, Montgomery M, Polansky R, Sachs CJ, Duber HC, et al. Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review. West J Emerg Med. 2017;18(6):1143–52.PubMedPubMedCentralCrossRef
2.
O’Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, et al. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol. 2014;49(1):66–78.PubMedCrossRef
3.
Joseph J, Basu D. Efficacy of brief interventions in reducing hazardous or harmful alcohol use in middle-income countries: systematic review of randomized controlled trials. Alcohol Alcohol. 2017;52(1):56–64.PubMedCrossRef
4.
Young MM, Stevens A, Galipeau J, Pirie T, Garritty C, Singh K, et al. Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Syst Rev. 2014;3(1):50.PubMedPubMedCentralCrossRef
5.
Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10:46.PubMedPubMedCentralCrossRef
6.
Pengpid S, Peltzer K, Puckpinyo A, Viripiromgool S, Thamma-Aphiphol K, Suthisukhon K, et al. Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10:22.PubMedPubMedCentralCrossRef
7.
Segatto ML, Andreoni S, de Souza e Silva R, Diehl A, Pinsky I. Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol-related problems: a randomized single-blind clinical trial. Braz J Psychiatry. 2011;33(3):225–33.
8.
Vendetti J, Gmyrek A, Damon D, Singh M, McRee B, Del Boca F. Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration. Addiction. 2017;112:23–33.PubMedCrossRef
9.
Holland CL, Pringle JL, Barbetti V. Identification of physician barriers to the application of screening and brief intervention for problem alcohol and drug use. Alcohol Treat Q. 2009;27(2):174–83.CrossRef
10.
Staton CA, Vissoci JRN, Wojcik R, Hirshon JM, Mvungi M, Mmbaga BT, et al. Perceived barriers by health care providers for screening and management of excessive alcohol use in an emergency department of a low-income country. Alcohol. 2018;71:65–73.PubMedPubMedCentralCrossRef
11.
Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health. 2011;33(3):412–21.CrossRef
12.
Mabood N, Zhou H, Dong KA, Ali S, Wild TC, Newton AS. Attitudes and beliefs towards patients with hazardous alcohol use. A systematic review. ISRN Emerg Med. 2012;2012:1–10.CrossRef
13.
van der Westhuizen C, Myers B, Malan M, Naledi T, Roelofse M, Stein DJ, et al. Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: a mixed methods evaluation study. PLoS ONE. 2019;14(11):e0224951.PubMedPubMedCentralCrossRef
14.
Schermer CR. Feasibility of alcohol screening and brief intervention. J Trauma-Injury Infect Crit Care. 2005;59(3):119–23; discussion S24–33.CrossRef
15.
Bernstein E, Topp D, Shaw E, Girard C, Pressman K, Woolcock E, et al. A preliminary report of knowledge translation: lessons from taking screening and brief intervention techniques from the research setting into regional systems of care. Acad Emerg Med. 2009;16(11):1225–33.PubMedCrossRef
16.
McNeely J, Kumar PC, Rieckmann T, Sedlander E, Farkas S, Chollak C, et al. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addict Sci Clin Pract. 2018;13(1):8.PubMedPubMedCentralCrossRef
17.
Sorsdahl K, Myers B, Ward C, Matzopoulos R, Mtukushe B, Nicol A, et al. Screening and brief interventions for substance use in emergency departments in the Western Cape province of South Africa: views of health care professionals. Int J Injury Control Saf Promot. 2013;21:236–43.CrossRef
18.
World Health Organization. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization; 2008.
19.
Hoeft TJ, Fortney JC, Patel V, Unützer J. Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review. J Rural Health. 2018;34(1):48–62.PubMedCrossRef
20.
Wamsley M, Satterfield JM, Curtis A, Lundgren L, Satre DD. Alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) training and implementation: perspectives from 4 health professions. J Addict Med. 2018;12(4):262–72.PubMedCrossRef
21.
Dwommoh R, Sorsdahl K, Myers B, Asante KP, Naledi T, Stein DJ, et al. Brief interventions to address substance use among patients presenting to emergency departments in resource poor settings: a cost-effectiveness analysis. Cost Effect Resour Alloc. 2018;16:24.CrossRef
22.
Topitzes J, Berger L, Otto-Salaj L, Mersky JP, Weeks F, Ford JD. Complementing SBIRT for alcohol misuse with SBIRT for trauma: a feasibility study. J Soc Work Pract Addict. 2017;17(1/2):188–215.CrossRef
23.
Broyles LM, Rosenberger E, Hanusa BH, Kraemer KL, Gordon AJ. Hospitalized patients’ acceptability of nurse-delivered screening, brief intervention, and referral to treatment. Alcohol Clin Exp Res. 2012;36(4):725–31.PubMedCrossRef
24.
Myers B, Stein DJ, Mtukushe B, Sorsdahl K. Feasibility and acceptability of screening and brief interventions to address alcohol and other drug use among patients presenting for emergency services in Cape Town, South Africa. Adv Prevent Med. 2012;2012:1–9.CrossRef
25.
Petersen Williams P, Brooke-Sumner C, Joska J, Kruger J, Vanleeuw L, Dada S, et al. Young South African women on antiretroviral therapy perceptions of a psychological counselling program to reduce heavy drinking and depression. Int J Environ Res Public Health. 2020;17(7):2249.PubMedCentralCrossRef
26.
Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018;13(1):98.PubMedPubMedCentralCrossRef
27.
Babor TF, Del Boca F, Bray JW. Screening, brief intervention and referral to treatment: implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction. 2017;112:110–7.PubMedCrossRef
28.
Hargraves D, White C, Frederick R, Cinibulk M, Peters M, Young A, et al. Implementing SBIRT (screening, brief intervention and referral to treatment) in primary care: lessons learned from a multi-practice evaluation portfolio. Public Health Rev. 2017;38:31.PubMedPubMedCentralCrossRef
29.
Herman AA, Stein DJ, Seedat S, Heeringa SG, Moomal H, Williams DR. The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. S Afr Med J. 2009;99(5 Pt 2):339–44.PubMedPubMedCentral
30.
Humeniuk R, Henry-Edwards S, Ali RL, Poznyak V, Monteiro M. The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care. Geneva: World Health Organization; 2010.
31.
WHO Assist Working Group. The alcohol, smoking and substance abuse involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183.CrossRef
32.
Peltzer K, Ramlagan S, Johnson BD, Phaswana-Mafuya N. Illicit drug use and treatment in South Africa: a review. Subst Use Misuse. 2010;45(13):2221–43.PubMedPubMedCentralCrossRef
33.
van der Westhuizen C, Wyatt GE, Williams JK, Stein DJ, Sorsdahl K. Validation of the alcohol, smoking and substance involvement screening test in a low- and middle-income country cross-sectional emergency centre study. Drug Alcohol Rev. 2016;35:702–9.PubMedCrossRef
34.
Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analyzing qualitative research. London: Routledge; 1994. p. 173–94.CrossRef
35.
Miller PM, Thomas SE, Mallin R. Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians. Alcohol Alcohol. 2006;41(3):306–10.PubMedCrossRef
36.
Rahm AK, Boggs JM, Martin C, Price DW, Beck A, Backer TE, et al. Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings. Subst Abuse. 2015;36(3):281–8.CrossRef
37.
Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82–6.PubMedCrossRef
38.
Knox J, Hasin DS, Larson FRR, Kranzler HR. Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry. 2019;6(12):1054–67.PubMedPubMedCentralCrossRef
39.
Brooks AC, Chambers JE, Lauby J, Byrne E, Carpenedo CM, Benishek LA, et al. Implementation of a brief treatment counseling toolkit in federally qualified healthcare centers: patient and clinician utilization and satisfaction. J Subst Abuse Treat. 2016;60:70–80.PubMedCrossRef
40.
Myers B, Parry CDH, Morojele NK, Nkosi S, Shuper PA, Kekwaletswe CT, et al. “Moving forward with life”: acceptability of a brief alcohol reduction intervention for people receiving antiretroviral therapy in South Africa. Int J Environ Res Public Health. 2020;17(16):5706.PubMedCentralCrossRef
41.
42.
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–89.PubMedCrossRef
43.
Kaner EF, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev. 2017;9(9):Cd011479.PubMed
44.
Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J, Patel V, et al. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry. 2017;4(6):486–500.PubMedPubMedCentralCrossRef
45.
46.
US Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US preventive services task force recommendation statement. JAMA. 2018;320(18):1899–909.CrossRef
47.
Barbosa C, Cowell A, Dowd W, Landwehr J, Aldridge A, Bray J. The cost-effectiveness of brief intervention versus brief treatment of screening, brief intervention and referral to treatment (SBIRT) in the United States. Addiction. 2017;112(S2):73–81.PubMedCrossRef
48.
Selohilwe O, Bhana A, Garman EC, Petersen I. Evaluating the role of levels of exposure to a task shared depression counselling intervention led by behavioural health counsellors: outcome and process evaluation. Int J Ment Health Syst. 2019;13(1):42.PubMedPubMedCentralCrossRef
49.
Chowdhary N, Anand A, Dimidjian S, Shinde S, Weobong B, Balaji M, et al. The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation. Br J Psychiatry. 2016;208(4):381–8.PubMedPubMedCentralCrossRef
50.
Ottman KE, Kohrt BA, Pedersen GA, Schafer A. Use of role plays to assess therapist competency and its association with client outcomes in psychological interventions: a scoping review and competency research agenda. Behav Res Therapy. 2019;130:103531.CrossRef
51.
Green HD. A community-based evaluation of screening, brief intervention, and referral to treatment (SBIRT) for the Black Community. Qual Health Res. 2018;28(3):418–32.PubMedCrossRef
52.
Bray JW, Del Boca FK, McRee BG, Hayashi SW, Babor TF. Screening, brief intervention and referral to treatment (SBIRT): rationale, program overview and cross-site evaluation. Addiction. 2017;112:3–11.PubMedCrossRef
53.
Myers B, Lund C, Lombard C, Joska J, Levitt N, Butler C, et al. Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial. Trials. 2018;19(1):185.PubMedPubMedCentralCrossRef
54.
Metadata
Title
Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study
Authors
Claire van der Westhuizen
Megan Malan
Tracey Naledi
Marinda Roelofse
Bronwyn Myers
Dan J. Stein
Sa’ad Lahri
Katherine Sorsdahl
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2021
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-021-00239-5

Other articles of this Issue 1/2021

Addiction Science & Clinical Practice 1/2021 Go to the issue

Research

Physician blame and vulnerability: novel predictors of physician willingness to work with patients who misuse opioids

Research

Smoking cessation using preference-based tools: a mixed method pilot study of a novel intervention among smokers with low socioeconomic position

Research

An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department

Research

Clinical leaders and providers’ perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs’ facilities

Correction

Correction to: Proceedings of the Addiction Health Services Research (AHSR) 2020: Virtual Conference: Part 2

Commentary

Adapting inpatient addiction medicine consult services during the COVID-19 pandemic