Progress Towards Integrating Behavioral Health and Primary Care in a Large Health Care System Through Implementation of SBIRT

Substance abuse in the United States is a serious public health concern. However, primary care physicians do not always identify or intervene with substance use disorders for a variety of reasons, including lack of time, lack of adequate training, and organizational factors. In partnership with SAMHSA, KPCO conducted a qualitative study of provider and patient perceptions of the Screening, Brief Intervention and Referral to Treatment (SBIRT), an evidence-based screening tool. KPCO then conducted a pilot demonstration of SBIRT implementation in one primary care clinic. Interviews and focus groups were conducted with KPCO physicians, nurses, therapists, patients, and operational leaders to determine the feasibility and acceptability of SBIRT and its implementation within the KPCO system. Additional focus groups were conducted with English-speaking and Spanish-speaking KPCO patients. Results helped characterize the current delivery of behavioral health services within the organization. KPCO determined that systems exist to facilitate SBIRT implementation into primary care, but that no regular work flow process exists in this organization for systematic screening for drug and alcohol use. All stakeholders agreed that this screening is necessary and that SBIRT is a good fit with current routine practice in primary care. After assessing feasibility, a pilot demonstration of SBIRT in primary care was conducted over a three-month time period, utilizing a behavioral medicine specialist to deliver the brief intervention for at-risk individuals. Results of this experience to date will be discussed.