A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of Care
A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of Care
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DOI：
10.1111/j.1553-2712.2009.00516.x
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发表时间：
2009-11-01
影响因子：
4.4
通讯作者：
Bernstein, Judith
中科院分区：
文献类型：
--
作者：
Bernstein, Edward;Topp, Deric;Bernstein, Judith
本文描述了一项有限的全州范围内的循证技术，筛查，短暂干预和转诊治疗（SBIRT）的传播，以及对急诊科（ED）护理系统的影响的评估，利用知识转化框架的范围，有效性，采用，实施和维护（RE-AIM），使用定量和定性数据源。筛查和短暂干预（SBI）可以在医疗环境中发现高风险和依赖酒精和药物的使用，提供早期干预，在适当情况下促进获得专业治疗，并提高护理质量。几项荟萃分析证明了它在初级保健中的有效性，联邦政府已经开展了一项资金充足的运动，以促进医生培训和采用SBI。在急诊科繁忙的环境中，研究人员测试了一种协作方法，这种方法依赖于具有药物滥用治疗经验和广泛社区联系的同伴教育者，作为医生的扩展者。ED- sbirt护理模式反映了临床医生、工作人员的时间限制和资源限制，并且是为ED患者的高患病率和高敏锐度而设计的。本报告跟踪了ED-SBIRT扩展模型在东北部州的城市、郊区和农村社区环境中向7个ed推广期间提供的服务。12名健康促进倡导者（hpa）被雇用、培训并融入7个ED团队。在18个月的启动期间，hpa筛查了15,383名患者；其中，4899人在高风险或依赖饮酒和/或吸毒方面呈阳性。在阳性筛查中，4035人（82%）接受了短暂干预，57%的阳性患者被转介到药物滥用治疗系统和其他社区资源。标准化的、保密的访谈是由两名项目外部的访谈者与24名知情者进行的，这些知情者包括五个站点的健康护理人员及其主管、临床医生、护士经理和急诊科主任。遵循详细的半结构化格式，并将结果编码为主题材料。受访者用自己的语言描述了障碍、挑战和成功，以传达他们对这次SBIRT知识翻译演示的经验。尽管政府削减了资金，但七所学校中的五所在第二年得以维持。传播过程为大规模推广提供了一些重要的经验教训。ED-SBIRT HPA模式的成功实施取决于1)外部启动资金；2)本地急诊科工作人员作为支持者，支持HPA的角色，解决领土问题，并促进急诊科治疗药物和酒精滥用的文化转变，从“治疗和街头”到预防，基于成瘾的科学知识；3)可持续性规划从一开始就涉及管理人员、计费和信息技术部门、医疗记录编码器、社区服务提供者和政府机构；4)建立和维持一个强大的转诊网络，以促进患者接受和获得药物滥用服务。
This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources.Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients.This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources.Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation.Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services.