Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio.
Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio.
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DOI：
10.1186/s40985-017-0077-0
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发表时间：
2017
影响因子：
5.5
通讯作者：
Elder N
中科院分区：
文献类型：
--
作者：
Hargraves D;White C;Frederick R;Cinibulk M;Peters M;Young A;Elder N
筛查、短暂干预和转诊治疗（SBIRT）是一种公共卫生框架方法，用于识别和向有物质使用障碍、抑郁症和其他精神健康状况风险的人提供服务。初级保健是许多患者进入医疗保健系统的第一步，SBIRT提供了早期识别这些患者并协助其治疗的潜力。在面向一线提供者和办公室工作人员的初级保健办公室实施SBIRT需要务实的“最佳实践”。10个初级保健实践获得了小额社区赠款，以在其所在地实施SBIRT方案。每个实践选择他们将筛选的条件，筛选工具，以及他们如何在其环境中提供简短的干预和转诊治疗。一个评估小组在整个过程中与每一个实践进行了沟通，收集了关于SBIRT成功的促进因素和障碍的定量和定性数据。使用编辑的方法，定性数据进行了分析，成功的关键策略详细实施SBIRT在初级保健。SBIRT计划的做法包括初级保健办公室，联邦合格的健康中心，学校为基础的健康中心，和安全网急诊科。筛查的条件包括酒精滥用、药物滥用、抑郁、焦虑、儿童安全和烟草使用。在整个实践中，49，964名患者有资格进行筛查，36，394名预筛查和21，635名全筛查完成。从定性数据，初级保健SBIRT的八个最佳实践进行了描述：有一个实践冠军;利用跨专业团队;定义和沟通每个SBIRT步骤的细节;发展与转诊合作伙伴的关系;机构正在进行的SBIRT培训;调整SBIRT与初级保健办公室流程;考虑使用预筛选工具，当可用时;和集成SBIRT到电子健康记录。SBIRT是一种有效的工具，可以使初级保健提供者在出现昂贵的症状之前识别和治疗有物质使用和心理健康问题的患者。使用我们所描述的务实的最佳实践，初级保健提供者可以提高他们的能力，成功地创建，实施和维持SBIRT在他们的做法。
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a public health framework approach used to identify and deliver services to those at risk for substance-use disorders, depression, and other mental health conditions. Primary care is the first entry to the healthcare system for many patients, and SBIRT offers potential to identify these patients early and assist in their treatment. There is a need for pragmatic “best practices” for implementing SBIRT in primary care offices geared toward frontline providers and office staff. Ten primary care practices were awarded small community grants to implement an SBIRT program in their location. Each practice chose the conditions for which they would screen, the screening tools, and how they would provide brief intervention and referral to treatment within their setting. An evaluation team communicated with each practice throughout the process, collecting quantitative and qualitative data regarding facilitators and barriers to SBIRT success. Using the editing method, the qualitative data were analyzed and key strategies for success are detailed for implementing SBIRT in primary care. The SBIRT program practices included primary care offices, federally qualified health centers, school-based health centers, and a safety-net emergency department. Conditions screened for included alcohol abuse, drug abuse, depression, anxiety, child safety, and tobacco use. Across practices, 49,964 patients were eligible for screening and 36,394 pre-screens and 21,635 full screens were completed. From the qualitative data, eight best practices for primary care SBIRT are described: Have a practice champion; Utilize an interprofessional team; Define and communicate the details of each SBIRT step; Develop relationships with referral partners; Institute ongoing SBIRT training; Align SBIRT with the primary care office flow; Consider using a pre-screening instrument, when available; and Integrate SBIRT into the electronic health record. SBIRT is an effective tool that can empower primary care providers to identify and treat patients with substance use and mental health problems before costly symptoms emerge. Using the pragmatic best practices we describe, primary care providers may improve their ability to successfully create, implement, and sustain SBIRT in their practices.