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Substance Abuse Treatment, Prevention, and Policy

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Open Access 01-12-2021 | Review

Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

Authors: Kelli Thoele, Laura Moffat, Stephanie Konicek, Monika Lam-Chi, Erica Newkirk, Janet Fulton, Robin Newhouse

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2021

Abstract

Background

Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes.

Methods

A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results.

Results

Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment.

Discussion

In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on drug use and health (HHS publication no. PEP19–5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2019. https://www.samhsa.gov/data/Accessed 30 Aug 2019.

Substance Abuse and Mental Health Services Administration. (2014). Projections of national expenditures for treatment of mental and substance use disorders, 2010–2020 HHS Publication No SMA-14-4883 Rockville, MD: Substance Abuse and Mental Health Services Administration 2014 https://storesamhsagov/system/files/sma14-4883pdf Accessed 30 Aug 2019.

National Institute on Drug Abuse. Trends & Statistics. 2019. https://www.drugabuse.gov/related-topics/trends-statistics#supplemental-references-for-economic-costs Accessed 30 Aug 2019.

Agley J, Carlson JM, McNeilis AM, Gassman RA, Schwindt R, Crabb D, Vannerson J. ‘Asking’ but not ‘screening: assessing physicians’ and nurses’ substance-related clinical behaviors. Subst Use Misuse, 2018;53(11):1834–1839. https://doi.org/https://doi.org/10.1080/10826084.2018.1438806.

Substance Abuse and Mental Health Services Administration. About screening, brief intervention, and referral to treatment (SBIRT). 2017. https://www.samhsa.gov/sbirt/about Accessed 30 Aug 2019.

Aldridge A, Linford R, Bray J. Substance use outcomes of patients served by a large US implementation of screening, brief intervention and referral to treatment (SBIRT). Addiction, 2017;112(Suppl. 2):43–53.https://doi.org/https://doi.org/10.1111/add.13651.

Barbosa C, Cowell A, Bray J, Aldridge A. The cost-effectiveness of alcohol of screening, brief intervention and referral to treatment (SBIRT) in emergency and outpatient medical settings. J Subst Abus Treat 2015;53:1–8.https://doi.org/ https://doi.org/10.1016/j.jsat.2015.01.003.

Quanbeck A, Lang K, Anami K, Brown RL. A cost-benefit analysis of Wisconsin’s screening, brief intervention, and referral to treatment program: adding the Employer’s perspective. Wis Med J. 2010;109(1):9–14.

Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018;(Issue 2) Art. No.: CD004148. https://doi.org/10.1002/14651858.CD004148.pub4.

10.

Young MM, Stevens A, Galipeau J, Pirie T, Garritty C, Sign K, … Moher D. 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;24:3:50. https://doi.org/https://doi.org/10.1186/2046-4053-3-50.

11.

Centers for Disease Control and Prevention. Planning and implementing screening and brief intervention for alcohol use: A step-by-step guide for primary care practices. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities. 2014 https://www.cdc.gov/ncbddd/fasd/documents/alcoholsbiimplementationguide.pdf Accessed 30 Aug 2019.

12.

Centers for Medicare and Medicaid Services. (2019). Screening, brief intervention, and referral to treatment (SBIRT) services 2019 https://wwwcmsgov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ SBIRT-Factsheet-ICN904084TextOnlypdf Accessed 30 Aug 2019.

13.

National Institute on Drug Abuse. Principles of drug addiction treatment: A research-based guide (3^rd edition). 2018. https://www.drugabuse.gov/node/pdf/675/ principles-of-drug-addiction-treatment-a-research-based-guide-third-edition. Accessed 30 Aug 2019.

14.

National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: A practitioner’s guide. NIH Publication No. 11–7805. 2019. https://www.niaaa.nih.gov/sites/default/files/publications/YouthGuide.pdf. Accessed 30 Aug 2019.

15.

Covington K, Johnson JA, Henry D, Chalmers S, Payne F, Tuck L, Seale JP. Alcohol and drug screening and brief intervention behaviors among advanced practice registered nurse (APRN) students in clinical settings. Appl Nurs Res 2018;39:125–129. https://doi.org/https://doi.org/10.1016/j.apnr.2017.11.015.

16.

Jun S, Plint AC, Curtis S, Newton AS. Screening, brief intervention, and referral to treatment (SBIRT) for adolescent alcohol use in emergency departments: a national survey of pediatric emergency physicians. Can J Emerg Med 2019;21(1):97–102. https://doi.org/https://doi.org/10.1017/cem.2018.390.

17.

Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. BMC Psychol, 2015;3:32. https://doi.org/https://doi.org/10.1186/s40359-015-0089-9, An introduction to implementation science for the non-specialist, 1.

18.

Lane-Fall MB, Curran GM, Beidas RS. Scoping implementation science for the beginner: locating yourself on the “subway line” of translational research. BMC Med Res Methodol. 2019;19:133. https://doi.org/https://doi.org/10.1186/s12874-019-0783-z, 1.

19.

Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82(4):581–629. https://doi.org/https://doi.org/10.1111/j.0887-378X.2004.00325.x.

20.

Aarons GA. Measuring provider attitudes towards evidence-based practice: consideration of organizational context and individual differences. Child Adolesc Psychiatr Clin N Am 2005;14(2):255–271 https://doi.org/https://doi.org/10.1016/j.chc.2004.04.008

21.

Rabin BA, Brownson RC, Haire-Joshu D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Manag Pract 2008;14(2):117–123. https://doi.org/https://doi.org/10.1097/01.PHH.0000311888.06252.bb.

22.

Wisdom JP, Chor KHB, Hoagwood KE, Horwitz SM. Innovation adoption: a review of theories and constructs. Admin Pol Ment Health 2014;41(4):480–502. https://doi.org/https://doi.org/10.1007/s10488-013-0486-4.

23.

Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci 2013;8:117. https://doi.org/https://doi.org/10.1186/1748-5908-8-117, 1.

24.

Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci 2013;8:129. https://doi.org/https://doi.org/10.1186/1748-5908-8-139, 1.

25.

Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE. A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project. Implement Sci 2015;10:21. https://doi.org/https://doi.org/10.1186/s13012-015-0209-1, 1.

26.

Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, Proctor EK, Kirchner JE. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the expert recommendations for implementing change (ERIC) study. Implement Sci 2015; 10:109. https://doi.org/https://doi.org/10.1186/s13012-015-0295-0, 1.

27.

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual definitions, measurement challenges, and research agenda. Admin Pol Ment Health, 2011;38: 65–76. https://doi.org/https://doi.org/10.1007/x10488-010-0319-, 2.

28.

Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health, 1999;89(9), 1322–1327. https://doi.org/https://doi.org/10.2105/AJPH.89.9.1322.

29.

Stoutenberg M, Galaviz KI, Lobelo F, Joy E, Heath GW, Hutber A, Estabrooks P. A pragmatic application of the RE-AIM framework for evaluating the implementation of physical activity as a standard of care in health systems. Prev Chronic Dis. 2018;15(E54). https://doi.org/https://doi.org/10.5888/pcd15.170344.

30.

Keurhorst M, van de Glind I, Amaral-Sabadini MBD, Anderson P, Kaner E, Newbury-Birch D, … Laurant M. Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis. Addiction, 2015;110, 1877–1900. https://doi.org/https://doi.org/10.1111/add.13088, 12.

31.

Nilsen P, Aalto M, Bendtsen P, Seppä K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare: a systematic review. Scand J Prim Health Care, 2006;24, 5–15. https://doi.org/https://doi.org/10.1080/02813430500475282, 1.

32.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8(1), 19–32. https://doi.org/https://doi.org/10.1080/1364557032000119616.

33.

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review of scoping review? Guidance for authors when choosing between a systematic or scoping review approach BMC Med Res Methodol 2018;18:143. https://doi.org/https://doi.org/10.1186/s12874-018-0611-x, 1.

34.

Lindholm C, Adsit R, Bain P, Reber PM, Brein T, Redmond L, et al. (2010). A demonstration project for using the electronic health record to identify and treat tobacco users. Wis Med J. 2010;109(6):335–40.

35.

Mello MJ, Bromberg J, Baird J, Nirenberg T, Chun T, Lee C, Linakis JG. Translation of alcohol screening and brief intervention guidelines to pediatric trauma centers. J Trauma Acute Care Surg. 2013;75(4 SUPPL. 3), S301–S307. https://doi.org/https://doi.org/10.1097/TA.0b013e318292423a.

36.

Muench J, Jarvis K, Gray M, Hayes M, Vandersloot D, Hardman J, Grover P Winkle J. Implementing a team-based SBIRT model in primary care clinics. J Subst Use, 2015;20(2):106–112. https://doi.org/https://doi.org/10.3109/14659891.2013.866176.

37.

Rieckmann T, Renfro S, McCarty D, Baker R, McConnell KJ. Quality metrics and systems transformation: are we advancing alcohol and drug screening in primary care? Health Serv Res 2018;53(3):1702–1726. https://doi.org/https://doi.org/10.1111/1475-6773.12716.

38.

Thomas P, Seale P, Johnson A, Dhabilwala J, Kitchens D, Okosum IS, et al. Impact of a quality improvement intervention to increase brief alcohol and drug interventions on a level I trauma service. Am Surgeon. 2016;82(5):468–73. https://doi.org/10.1177/000313481608200524.CrossRefPubMed

39.

Whitty M, Nagel T, Ward L, Jayaraj R, Kavanagh D. Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study. Aust NZ J Publ Health, 2015;39(3), 216–221. https://doi.org/https://doi.org/10.1111/1753-6405.12375.

40.

Zimmermann E, Sample JM, Zimmermann ME, Sullivan F, Stankiewicz S, Saldinger P. Successful implementation of an alcohol screening, brief intervention, and referral to treatment program. J Trauma Nurs 2018;25(3), 196–200. https://doi.org/https://doi.org/10.1097/JTN.0000000000000368.

41.

Sharifi M, Adams WG, Winickoff JP, Guo J, Reid M, Boynton-Jarrett R. Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke. Acad Pediatr 2014;14(5), 478–484. https://doi.org/https://doi.org/10.1016/j.acap.2014.03.017.

42.

Mello MJ, Baird J, Nirenberg TD, Smith JC, Woolard RH, Dinwoodie, R. G. project integrate: translating screening and brief interventions for alcohol problems to a community hospital emergency department. Subst Abuse, 2009;30(3), 223–229. https://doi.org/https://doi.org/10.1080/08897070903040956.

43.

Anderson P, Bendtsen P, Spak F, Reynolds J, Drummond C, Segura L, Keurhorst M.N., Palacio-Vieira J., Wojnar M., Parkinson K., Colom J., Kłoda K., Deluca P., Baena B., Newbury-Birch D., Wallace P., Heinen M., Wolstenholme A., van Steenkiste B., Mierzecki A., Okulicz-Kozaryn K., Ronda G., Kaner E., Laurant M.G.H., Coulton S. Gual T. Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the optimizing delivery of health care intervention (ODHIN) five-country cluster randomized factorial trial. Addiction. 2016;111(11), 1935–1945. https://doi.org/https://doi.org/10.1111/add.13476.

44.

Henihan AM, McCombe G, Klimas J, Swan D, Leahy D, Anderson R, Bury G, Dunne CP, Keenan E, Lambert JS, Meagher D, O’Gorman C, O’Toole TP, Saunders J, Shorter GW, Smyth BP, Kaner E Cullen W. Feasibility of alcohol screening among patients receiving opioid treatment in primary care. BMC Fam Pract 2016;17:153. https://doi.org/https://doi.org/10.1186/s12875-016-0548-2, 1.

45.

Bendtsen P, Mussener U, Karlsson N, Lopez-Pelayo H, Palacio-Vieira J, Colom J, … Anderson P. Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial. BMJ Open, 2016;6(6), e010271. https://doi.org/https://doi.org/10.1136/bmjopen-2015-010271asdf.

46.

Mertens JR, Chi FW, Weisner CM, Satre DD, Ross TB, Allen S, Pating D, Campbell CI, Lu YW Sterling SA. Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial. Addict Sci Clin Pract. 2015;10: 26. https://doi.org/https://doi.org/10.1186/s13722-015-0047-0, 1.

47.

Salvalaggio G, Dong K, Vandenberghe C, Kirkland S, Cummings GG, McKim R, et al. Effect of a knowledge translation intervention on physician screening, brief intervention, and referral to treatment behaviour in a socioeconomically disadvantaged setting. Can J Addict. 2015;6(1):7–14.CrossRef

48.

Sterling S, Kline-Simon AH, Satre DD, Jones A, Mertens J, Wong A, Weisner C. Implementation of screening, brief intervention, and teferral to treatment for adolescents in pediatric primary care: a cluster randomized trial. JAMA Pediatr, 2015;169(11), e153145. https://doi.org/https://doi.org/10.1001/jamapediatrics.2015.3145.

49.

Lapham GT, Achtmeyer CE, Williams EC, Hawkins EJ, Kivlahan DR, Bradley KA. Increased documented brief alcohol interventions with a performance measure and electronic decision support. Med Care 2012;50(2), 179–187. https://doi.org/https://doi.org/10.1097/MLR.0b013e3181e35743.

50.

Egizio LL, Smith DC, Bennett K, Campbell C, Windsor L. Field supervision training for a screening brief intervention and referral to treatment (SBIRT) implementation project. Clin Soc Work J 2019;47, 53–60. https://doi.org/https://doi.org/10.1007/s10615-018-0686-1, 1.

51.

Bernstein E, Bernstein J, Feldman J, Fernandez W, Hagan M, Mitchell P, Safi C, Woolard R, Mello M, Baird J, Lee C, Bazargan-Hejazi S, Broderick K, Laperrier KA, Kellermann A, Wald MM, Taylor RE, Walton K, Grant-Ervin M, Rollinson D, Edwards D, Chan T, Davis D, Buchanan Marshall J, Aseltine R, James A, Schilling E, Abu-Hasaballah K, Baumann BM, Boudreaux ED, Maio RF, Cunningham RM, Murrell T, Doezema D, Anglin D, Eliassen A, Martin M, Pines J, Buchanan L, Turner J, D'Onofrio G, Degutis LC Owens P. An evidence-based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Subst Abuse, 2007;28(4), 79–92. https://doi.org/https://doi.org/10.1300/J465v28n04_01.

52.

American College of Surgeons Committee on trauma. Alcohol screening and brief intervention (SBI) for trauma patients: COT quick guide. 2007. https://www.facs.org/~/media/files/quality%20programs/trauma/publications/sbirtguide.ashx Accessed 15 Feb 2020. February 15, 2020.

53.

U.S. Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US preventative services task force recommendation statement. JAMA, 2018;320(18), 1899–1909. https://doi.org/https://doi.org/10.1001/jama.2018.16789.

54.

Center for Health Information and Analysis. Behavioral health & readmissions in Massachusetts acute care hospitals. 2019. http://www.chiamass.gov/assets/docs/r/pubs/19/Behavioral-Health-Readmissions-2019.pdf. Accessed 7 Feb 2020.

55.

McQueen J, Howe TE, Allan L, Mains D, Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev, 2011, Issue 8. Art. No.: CD005191. https://doi.org/ https://doi.org/10.1002/14651858.CD005191.pub3

56.

The Joint Commission. Specifications manual for Joint Commission national quality measures (v2020A2). 2019. https://manual.jointcommission.org/releases/TJC2020A2/. Accessed 15 Feb 2020.

57.

McNeely J, Kumar PC, Rieckmann R, Sedlander E, Farkas S, … Rotrosen J. 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;13:8. https://doi.org/https://doi.org/10.1186/s13722-018-0110-8asdf, 1.

58.

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), 725–731. https://doi.org/https://doi.org/10.1111/j.1530-0277.2011.01651.x.

59.

Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Admin Pol Ment Health 2011;38(1), 4–23. https://doi.org/https://doi.org/10.1007/s10488-010-0327-7.

Title: Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review
Authors: Kelli Thoele
Laura Moffat
Stephanie Konicek
Monika Lam-Chi
Erica Newkirk
Janet Fulton
Robin Newhouse
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: Substance Abuse Treatment, Prevention, and Policy / Issue 1/2021
Electronic ISSN: 1747-597X
DOI: https://doi.org/10.1186/s13011-021-00380-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

Abstract

Background

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Discussion

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