SBIRT Implementation in the Clinical Setting

Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based approach to early intervention for persons at risk for alcohol use disorders. Because few medical residency training programs include SBIRT training and few physicians routinely incorporate SBIRT into clinical practice, we initiated a 5-year multidisciplinary training curriculum which targeted 539 resident physicians from six medical specialties across South Texas. In addition to enhancing knowledge, attitudes and the implementation of SBIRT practices during the residency program, we examined whether our training efforts led to the continued implementation of SBIRT practices post-graduation. As of December 2011, 53 out of an eligible 109 had completed a 12-month survey and 23 out of an eligible 58 had completed a 24-month survey. At 12-months, graduates reported screening approximately 68% of patients for tobacco use or exposure during a typical practice day and used a validated, brief screening tool (e.g CAGE) 39% of the time. Physicians reported that almost half of the patients they see are given a brief intervention for tobacco cessation and risky alcohol use at least once per week. Lastly, 38% of graduates refer patients to treatment approximately one or two times a month. 24-month surveys showed similar results but in decreased proportions (57% screening, 30% screening with a validated screening tool). The frequency of brief interventions and referrals to treatment declines at 24-months as well. This study shows that implementing residency program SBIRT training can increase AOD identification and treatment referral, but training needs reinforcement for sustained clinical practice use.