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Article Title

Large-Scale Implementation of Alcohol SBIRT in Adult Primary Care in an Integrated Health Care Delivery System: Lessons From the Field

Publication Date

8-15-2016

Keywords

SBIRT, implementation

Abstract

Background/Aims: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been shown to be an efficacious intervention for risky drinkers and is recommended by numerous national organizations (NIH, USPSTF, SAMHSA, CDC). Nevertheless, large-scale implementation of SBIRT has proven to be challenging.

Methods: The roll-out of systematic adult alcohol SBIRT in Kaiser Permanente Northern California built on and scaled up the findings from a National Institute on Alcohol Abuse and Alcoholism-funded cluster-randomized implementation trial (ADVISe) of different modalities of SBIRT delivery –– primary care provider (PCP)-delivered versus delivery by nonphysician provider. Based on findings from ADVISe, a hybrid SBIRT model was chosen for implementation in which evidence-based alcohol screening instruments and clinical decision support tools were developed for the health system’s electronic health record, medical assistants were trained to screen all patients in adult medicine and PCPs were trained in brief intervention and referral to treatment techniques. Curricula and procedures were developed for medical assistant and PCP training, skills reinforcement and troubleshooting. Structures and protocols were created for communicating provider- and facility-level screening and brief intervention performance. We developed a network of “alcohol champions” across the health system within adult medicine and established collaborative relationships between medicine and chemical dependency programs to facilitate the seamless referral to and receipt of patients in specialty substance abuse treatment.

Results: Since the initial roll-out in July 2013, there have been 2,502,455 alcohol screenings on unique adult primary care patients; 3,575,039 total screenings have occurred including follow-up screenings for risky drinkers. The 86% regional rate of alcohol screening has exceeded tobacco and exercise screening. Brief intervention rates across the 15 medical centers in the region range from 31% to 71%, with a current regional mean brief intervention rate of 54%.

Conclusion: We will discuss the challenges to and critical stakeholder involvement in the successful large-scale implementation of research findings and make recommendations for structures and approaches that may facilitate adoption of SBIRT within health systems.

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