218205 Implementing SBIRT in a rural, mountain primary care clinic: Exploring processes and outcomes

Tuesday, November 9, 2010

Laura Rivera, PhD , OMNI Institute, Denver, CO
Melissa Richmond, PhD , OMNI Institute, Denver, CO
The goal of this study was to better understand processes involved in integrating the SBIRT program into a clinic's operations and to examine the impact of these efforts on staff, patients, the clinic, and the community. The study was conducted in a Colorado rural, mountain primary care clinic serving uninsured patients, approximately half of whom identified as Hispanic and were primary Spanish speakers. During the 8 month study period, 1,151 patients received SBIRT screening and services for alcohol and illicit substances (services were provided in patients' primary language). 21% of patients were identified by the ASSIST as needing a brief intervention, and 5% were in need of additional services. Risk among those identifying as White was much higher (46%) than for those identifying as Hispanic (6%) or Black (4%). Patients were most often at-risk for unhealthy use of cannabis (19%) and alcohol (9%). Data were collected from 517 patients during 6 month follow-up interviews: patients reported significantly fewer days of cannabis use, alcohol use and binge drinking. Interviews and focus groups with clinic staff indicated that SBIRT improved the quality of care: knowledge of substance use behaviors allowed for more accurate diagnoses and treatment and the community viewed the clinic as holistic and progressive. The greatest challenge staff reported was integrating screening into clinic flow. Findings suggest SBIRT had a positive impact on the clinic and patients. Unique profiles of patient demographics and patterns of risk in this clinic highlight the importance of understanding community factors and tailoring implementation appropriately.

Learning Areas:
Implementation of health education strategies, interventions and programs

Learning Objectives:
1. Discuss how community factors that influence substance use behaviors can impact SBIRT implementation. 2. Identify possible solutions to SBIRT implementation challenges, such as how to better integrate screening into clinic flow. 3. Discuss the pros and cons of screening for illicit substances in addition to alcohol.

Keywords: Screening, Substance Abuse Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am an evaluator for SBIRT Colorado, a substance abuse prevention program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.