SBIRT clinical practice guideline development and implementation methods in Colorado

Colorado Clinical Guidelines Collaborative (CCGC) is a statewide collaboration of more than 50 organizations including health plans, universities, medical societies, public health departments, local health organizations, clinicians, and state agencies working to improve health care quality and efficiency. CCGC develops one-page clinical guidelines on prevention and disease management to support implementation of evidence-based practices. CCGC developed a Screening Brief Intervention Referral to Treatment (SBIRT) guideline that addresses tobacco, alcohol and drugs. During 2009 CCGC provided one-hour, on-site trainings in 13 diverse primary care settings to introduce the guideline; and then engage the entire practice staff to develop an implementation plan with attention to team responsibilities, work flow, electronic and paper tracking, and further training needs (i.e., motivational interviewing). Follow-up by phone over the course of six months assessed implementation and offered further assistance. After six months, 9/13 practices had implemented SBIRT. Factors associated with implementation included an overall commitment to prevention and validated screening tools; standardization of intake forms, staff responsibilities, and practice flow; utilization of non-clinician staff to do SBI, perceived high prevalence of substance abuse in the population, recognition of the association of alcohol misuse with common health problems, and feedback from individual patients that SBI improved their health. Challenges included reaching consensus among providers about substance abuse prevention, limited options for referral for treatment and a need for additional training to become comfortable with brief intervention techniques. Future plans include development of an online training module with video demonstration of SBI and materials on motivational interviewing.