We Ask Everyone: Design and Implementation of an SBIRT Initiative in a Community-Based Primary Care Teaching Clinic

SBIRT (screening, brief intervention, and referral to treatment) has been shown to reduce substance use and related consequences in primary care settings. Organizational SBIRT adoption and implementation requires buy-in and coordination of multiple stakeholders. This initiative sought to develop and test training and implementation resources for physicians and clinic staff at a high-volume (30,000 patients/year), community-based, ethnically-diverse adult primary care clinic, which serves as primary practice site for over 55 resident and faculty physicians. Development followed a multistage iterative process involving multiple disciplines: physicians, mental health counselors, educators and assessment experts. We chose various methods of educational dissemination: web-based training, face-to-face sessions, and interactive workshops. We implemented clinic-based patient screening, hired an onsite substance counselor for treatment referrals, printed formal screening tools and posters, reminding everyone of our core message: “We ask everyone.” Program design began October 2009. Web-based and SBIRT training of residents and faculty began April 2010. Sixty-nine residents have received training. Thirty days post-training, 78% of participants said they have applied the skills learned. Over 90% said they are likely to ask patients about their alcohol consumption patterns. Implementation of screening began January 28, after training sessions for clinic staff. Approximately 400 patients have been screened: 7% screening positive for hazardous drinking, 35% for tobacco use, and 4% for drug abuse. The rollout has been well-received by physicians and staff; however, barriers and challenges remain including tracking outcomes of the physicians' brief interventions. Next steps will involve ongoing staff/physician training and electronic reminders for use by physicians.