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

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.