SBIRT SCREENING AND MOTIVATIONAL INTERVIEWING

Transcription

1 SBIRT SCREENING AND MOTIVATIONAL INTERVIEWING

2 JELLICO, TENNESSEE

3 DAYSPRING FAMILY HEALTH CENTER Cumberland River Clinic Indian Mountain Clinic Clear Fork Clinic

4 SUBSTANCE USE CONTINUUM Ranging from Abstinence Moderate use (lower risk use) At-risk use (higher risk use) Abuse Dependence Substance Use Disorders (SUD)

5 Continuum of Substance Use Severity ABSTAINERS and LOW-RISK USERS (70%) MODERATE TO HIGHER RISK 25% SEVERE and DEPENDENT (5%)

6 WHAT IS SBIRT? S - Screening BI Brief Intervention RT Referral to Treatment

7 HOW? Two questions for all patients at intake, on alcohol and recreational drug use Follow up screen (10 questions) for those at risk (20-25% of patients) Language and protocols for discussing substance use effectively Confidence that health related substance issues are being raised

8 The SBIRT Method +

9 SBIRT PRE-SCREEN QUESTIONS One Drink = Men: How many times in the past year have you had 5 or more drinks in a day? Women: How many times in the past year have you had 4 or more drinks in a day? How many times in the past year have you used a recreational drug or used a prescription medication for nonmedical reasons?

10 WHAT CONSTITUTES ONE DRINK?

11 1.5-oz spirits 80-proof (1 jigger) ONE DRINK 5-oz glass of wine (5 glasses in one bottle) 12-oz glass of beer (one can)

12 HOW MUCH?

13 HOW MUCH?

14 DRUGS

15 IMPACT OF SCREENING/BRIEF INTERVENTION 13-34% reduction in alcohol use at 12 months (Moyer et al, 2002; Whitlock et al, 2004; Bertholet et al, 2005) 20% fewer ED visits, 33% fewer nonfatal injuries, 37% fewer hospitalizations, 46% fewer arrests, 50% fewer motor vehicle crashes (Fleming et al 2000) Most effective approach for people not seeking treatment, based on meta-analysis of 360 trials (Miller et al, 2002)

16 IMPACT OF SCREENING/BRIEF INTERVENTION US Preventive Task Force Category B recommendation Some evidence of effectiveness Similar to Smoking Cessation, breast cancer screening, STD screening

17 DEVELOP PROTOCOL What staff is available Who is qualified Strengths/weaknesses

18 TEAM COORDINATION / WORKFLOW Team Assignments Everyone plays a part Well assigned responsibilities Accountability

19 WORKFLOW DEVELOPMENT Consider flow Physical Space Communicative space EHR / Template Space

20 WORKFLOW DEVELOPMENT Computerized survey Paper Survey Oral Questions Cue Cards

21 The SBIRT Method

22 TEAM COORDINATION / WORKFLOW Workflow Simple Clearly define Designed to max info / save timec

23 The SBIRT Method

24 The SBIRT Method

25

26 TEMPLATE / EHR DESIGN Decide Document Order Track

27 MOTIVATIONAL INTERVIEWING

28 MOTIVATIONAL INTERVIEWING This is the primary intervention of brief intervention Guided Conversation Elicit the patient s motivation for change

29 MOTIVATIONAL INTERVIEWING Focus on MEDICAL issues!

30 MOTIVATIONAL INTERVIEWING Open Ended Questions Affirmation Reflective Listening Summarizing to Communicate

31 MOTIVATIONAL INTERVIEWING Ask Permission Provide Feedback Enhance Motivation Provide Advice Discuss Next Steps Close on Good Terms

32 MOTIVATIONAL INTERVIEWING

33 MOTIVATIONAL INTERVIEWING Ask Permission I appreciate your answering our health questionnaire. Can we take a moment to discuss your results? Patient may answer yes or no

34 MOTIVATION FOR CHANGE

35 MOTIVATIONAL INTERVIEWING Provide Feedback Refer to MEDICAL evidence that demonstrates possible problem As your provider, I wanted to mention that drinking at this level can be harmful to your health, and possibly be related to the health problem for which you came in today. I am interested in knowing what you make of that?

36 MOTIVATIONAL INTERVIEWING Enhance Motivation What are some of the good/not so good things about your substance use? On a scale of 1-10, how important is it that you cut back on your [substance] use? If > 0 - why that number (and not a lower /higher one) If so - Why If not What would have to happen for you to consider cutting back?

37 MOTIVATIONAL INTERVIEWING Provide Advice Focus on MEDICAL issues Symptoms / side effects / withdrawal Show them NIH chart for numbers of drinks a day If you go a day or 2 without using, do you ever get sick, shaky, have tremors/seizures, or see/hear things that are not there?

38 MEDICAL EFFECTS OF ALCOHOL Cirrhosis Depression Heart Disease GERD PUD Stroke

39 MOTIVATIONAL INTERVIEWING Discuss Next Steps If you were to make a change what would be your first/next step?

40 MOTIVATIONAL INTERVIEWING Close on Good Terms Summarize Emphasize patient s strengths Highlight change talk, and decisions made Arrange for follow up as appropriate Referral to Treatment

41 FOR MORE INFORMATION Federal and Tennessee websites To participate in TN: Barbara Clinton: Matt Rafalski:

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43 DATA STRUCTURE What parameters do you want to measure Quantitative, Qualitative Precision Accuracy

44 RULES / REMINDERS

45 DATA VALIDATION All possible variable returned DAST01 DAST survey positive Expected results Compare Across subgroups SBIRT05 SBIRTDA SBIRT01 SBIRT Positive and Motivational Interview Done SBIRT POSITVE and DAST Done SBIRT Screening Done

46 DATA REVIEW SBIRT 1st Q 2015 Results Count of Patient_FileID VisitCPT_Description Total AUDIT Survey Positive 5 DAST survey positive 6 NULL 110 SBIRT Addressed by Provider 17 SBIRT POSITIVE and AUDIT Done 7 SBIRT Positive and Motivational Interview Done 3 SBIRT POSITVE and DAST Done 5 SBIRT Screen Positive 162 SBIRT Screening Done 2280 Grand Total 2595

47 DATA REVIEW SBIRT Screen Done 88% SBIRT Screen Positive 7% On POSITIVE SBIRTS DAST/AUDIT Done 7% DAST Positive 120% AUDIT Positive 71% ADDRESSED by Provider 10%

48 DATA RESULTS 100% Dayspring SBIRT Screening 90% 80% 70% Axis Title 60% 50% 40% Percent SBIRT Done Percent SBIRT Positive Percent Addressed by Provider 30% 20% 10% 0% Q Q Q

49 DATA IMPROVEMENT

50 DATA IMPROVEMENT

51 DATA IMPROVEMENT Why is the positive screens lower than expected? What barriers are there to follow up of a positive patient screen? Is the data tracking set up correctly How can we enhance the intervention given limited resources?

52 DATA IMPROVEMENT

53 DATA PRESENTATION SBIRT screening at a rural clinic achieved high % in 6-9 months Improvement in follow up is needed CDS not as easy to implement here Long term follow can be done to see if improvements in the population occur Populations Management to Look follow up individuals with a positive screen