Integrating SBIRT into Primary Care: Aligning Technology with the Health Care Team

May 14th, 2014

Hannah Knudsen, PhD
University of Kentucky

When considering the question posed by Dr. Roman for this issue of The Bridge—“What could each of us do to enhance physician involvement in identifying and assisting individuals with substance use disorders?”—I was initially pessimistic about my ability to make any useful suggestions. It is a challenging question. My initial reaction as a researcher was to start mentally listing all the barriers to physician involvement, of which there are many. But then I found myself re-visiting a failed grant application that we submitted a couple of years ago that sought to implement SBIRT in our academic medical center’s internal medicine clinics.

We knew, based on data from our state, that there was a clear need for greater screening to identify patients who might benefit from further intervention. Epidemiological data had shown that Kentucky had slightly lower rates of illicit drug use (7.4%) and binge drinking (21.6%) relative to the nation, but much higher rates of smoking (34.0%).  At the time, Kentucky had the sixth-highest rate of nonmedical prescription pain reliever use, and Kentucky binge drinkers had the highest mean number of binge episodes in the US.

From our perspective, improving care for patients with SUDs might be enhanced through an SBIRT model that integrated technology and medical extenders within the primary care clinic setting. When we were developing this grant application, our medical center had not yet transitioned to electronic health records, so integrating technology into the clinic had some novelty. The technology itself was actually relatively simple—we proposed to develop a web-based app deployed on an iPad® that relied upon ultra-brief (i.e., single item) screening measures of tobacco , alcohol, non-medical prescription and illicit drug use that could be collected by a nurse at the time that other vital signs were measured. Positive responses to the alcohol and/or drug screeners would lead to two additional brief screening tools, the three-item AUDIT-C and/or the 10-item DAST. The app would then calculate risk scores, and for patients with scores indicative of risk, the app would generate examples of brief advice for the physician to use when he or she met with the patient in the examination room. Specifically, the physician would be prompted to: (1) deliver brief advice messages based on the risk level and (2) refer patients with positive screens to a medical extender, in this case a behavioral health specialist, who would then conduct a more thorough assessment and make additional referrals to treatment. We hoped that by including a “button” on the iPad® that would send an automated, encrypted email to a behavioral health specialist that physicians could easily link patients to additional care.

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Posted in SBIRT


A Project of the Governor's Institute on Alcohol & Substance Abuse and the North Carolina Society of Addiction Medicine.
Funded wholly or in part by the federal Substance Abuse Prevention and Treatment Block Grant Fund (CFDA #93.959) as a project of the NC Division of Mental Health, Developmental Disabilities & Substance Abuse Services.