Screening, Brief Intervention, and Referral to Treatment (SBIRT) Why is it Important?

Transcription

1 Screening, Brief Intervention, and Referral to Treatment (SBIRT) Why is it Important? Dr. Christine Savage Southeastern Consortium for Substance Abuse Training Advanced Practice Registered Nurses Funded by Grant 1U79T Substance Abuse and Mental Health Services Administration (SAMHSA) Last revised: August 18, 2014 Funded Funded by: by:

2 Key Contributors & SECSAT APRN Site Coordinators Mercer University, School of Medicine J. Paul Seale, MD Principal Investigator Annie Biers, LPC Project Coordinator Sylvia Shellenberger, PhD Mercer University, Georgia Baptist College of Nursing Frieda Fuller Payne, DSN, FNP-BC Armstrong Atlantic University Anita Nivens, PhD, RN, FNP-BC Linda Tuck, DNP, APRN-BC Emory University, Nell Hodgson Woodson School of Nursing Carolyn Clevenger, DNP, GNP-BC Ursula Kelly, PhD, ANP-BC, PMHNP-BC Phyllis Wright, DNP, GNP-BC University of North Georgia Sharon Chalmers, PhD, CNE, APRN-BC, FNP South University Laura McKay, DNP, APRN, CNM Johns Hopkins University Christine Savage, PhD, RN, CARN, FAAN Deborah Finnell, DNS, PHMHP-BC, CARN-AP, FAAN Georgia College & State University Deborah MacMillan, PhD, CNM Sallie Coke, PhD, APRN, C-PNP, C-FNP University of Alabama, Birmingham Susanne Fogger, DNP, CRNP, PMHNP-BC

3 Learning Objectives By the end of this session participants will able to Define SBIRT and its supporting evidence. Describe SBIRT s value for patients, payers, policymakers, physicians, and allied health and human service professionals. Better answer the question: Why might I choose to support SBIRT implementation? 3

4 What Is SBIRT and Why Use It? 4

5 SBIRT Defined Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services. It is used for Persons with substance use disorders Those whose use is at higher levels of risk Primary care centers, hospitals, and other community settings provide excellent opportunities for early intervention with at-risk substance users and for intervention for persons with substance use disorders. 5

6 What Is SBIRT? An intervention based on Motivational Interviewing strategies Screening: Universal screening for quickly assessing use and severity of alcohol; illicit drugs; and prescription drug use, misuse, and abuse Brief Intervention: Brief motivational and awareness-raising intervention given to risky or problematic substance users Referral to Treatment: Referrals to specialty care for patients with substance use disorders Treatment may consist of brief treatment or specialty AOD (alcohol and other drugs) treatment. National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking, MMWR 2012:61:

7 Why Might I Choose to Support SBIRT Implementation? 7

8 Questions you may be asking Q: Do I really have to do this thing? A: It s your choice and we hope you will find your own personal reasons for doing it. Q: How much hassle is involved? A: There are a few challenges with starting up, but it can be made easy and routine, as with taking a blood pressure. Q: Will it annoy my patients? A: See next slide 8

9 Patients Are Open To Discussing Their Substance Use To Help Their Health Survey on Patient Attitudes Agree/Strongly Agree If my doctor asked me how much I drink, I would give an honest answer. If my drinking is affecting my health, my doctor should advise me to cut down on alcohol. As part of my medical care, my doctor should feel free to ask me how much alcohol I drink. I would be annoyed if my doctor asked me how much alcohol I drink. I would be embarrassed if my doctor asked me how much alcohol I drink. 92% 96% 93% Disagree/Strongly Disagree 86% 78% Source: Miller, P. M., et al. (2006). Alcohol & Alcoholism. Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum ( 9

10 Why Is SBIRT Important? According to NIDA (2012): since the 1980 s mortality related to drug use has more than doubled. Substance use (alcohol, drug and tobacco) is attributable to one in four deaths, more than from any other preventable health condition. 10

11 Why Is SBIRT Important? The costs to society are more than $600 billion annually. ( NIDA, 2012, Effects of unhealthy and unsafe alcohol and drug use have far-reaching implications for the individual, family, workplace, community, and the health care system. 11

12 Epidemiology of Alcohol Use Alcohol use: Accounts for 4% of the global burden of disease. Is 8 th among global risk factors for death. Is the 3 rd leading cause of death and disability. For those age it is the leading cause of death and disability. Cancer accounts for 21.6% of all alcohol attributable deaths. In high income countries, cost associated with alcohol accounts for more than 1% of the gross national product. Source: WHO (2011) 12

13 Alcohol Use Among Women of Childbearing Age In 2004, 11.2% of pregnant women aged 15 to 44 reported alcohol use and 4.5% reported binge drinking. Among non-pregnant women of childbearing age, 52.8% reported alcohol use and 23.3% reported binge drinking. Half of all pregnancies are unplanned, and many women will not know they are pregnant during the early weeks of gestation and may continue drinking. Identifying women who are at high risk for an alcoholexposed pregnancy and intervening with them before conception (or at least as early as possible thereafter) is an essential strategy for preventing alcohol-exposed pregnancies. Source: 13

14 Alcohol Use: Just how much do we drink in the U.S.? The prevalence varies based on: Region of the country Gender Age Race/ethnicity Current use in the US in 2012 Those aged 12 and older: 52.1% Those aged 21-25: 69.2% Source: National Survey and Drug Use and Health 14

15 At-Risk Use Quantity how much? Frequency how often? Pattern - how consumed (heavy episodic), continuous? Duration over the life time? 15

16 Binge Drinking Binge Drinking heavy episodic drinking excessive drinking 5 or more drinks for men on one occasion 4 or more drinks for women on one occasion Source: NIAAA (2007) 16

17 Over the Limit A blood alcohol concentration (BAC) level of 0.08 grams: usually occurs with the consumption of 4 or more drinks in about 2 hours (3 or more with women). Results in trouble controlling speed and difficulty processing information and reasoning Source: Centers for Disease Control and Prevention (2011) 17

18 Current Binge and Heavy Alcohol Use: Persons Aged Twelve or over by age group 2012 Source: National Survey on Drug Use and Health

19 Low Risk Alcohol Use Source: NIAAA (2013) 19

20 US Drug Use Prevalence % 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Illicit drug use Marijuana cocaine hallucinogens psychotheraputics Source: National Survey on Drug Use and Health (2013) 20

21 Harms Related to Hazardous Alcohol and Substance Use Increased risk for Injury/trauma Criminal justice involvement Social problems Mental health consequences (e.g., anxiety, depression) Increased absenteeism and accidents in the workplace Source: US DHHS, Healthy People 2020 (2013). > 65 diseases/conditions associated with or caused by harmful use of alcohol. (Warren & Murray, 2013) 21

22 Unfortunately, these kinds of experiences remain too commonplace 22

23 Medical and Psychiatric Harm of High-Risk Drinking Source Babor, Thomas F., Higgins-Biddle, John C., Saunders, John B., and Monteiro, Maristela G (2 nd edition; June 2006)., The Alcohol Use Disorders Identification Test: Guidelines for use in primary care, WHO, Management of substance abuse: Alcohol 23

24 The Evidence Indicates That Moderate-Risk and High-Risk Drinkers Account for the MOST Problems 24

25 Historic Response to Substance Use Previously, substance use intervention and treatment focused primarily on substance abuse universal prevention strategies and on specialized treatment services for those who met the abuse and dependence criteria. There was a significant gap in service systems for atrisk populations. 25

26 Shifting the Paradigm From detection of alcohol use disorders to identification of health risk. 26

27 Rethinking Substance Use Problems From a Public Health Perspective 27

28 In the Emerging Public Health Paradigm, All Services Are Aligned Primary Prevention Early intervention Treatment Maintenance Universal Prevention Selective Prevention Indicated Prevention SBIRT and other brief interventions Evidence-based practices with recovery supports (Recovery-Oriented Systems of Care ROSC) Recovery supports, self-help other peer support. (ROSC) 28

29 Screening versus Assessment Screening for atrisk use and Alcohol Use Disorders (AUD). Assessment for risk of adverse alcohol-related health effects. 29

30 Goal The primary goal of SBIRT is to identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use. 30

31 Research Demonstrates Effectiveness A growing body of evidence about SBIRT s effectiveness including costeffectiveness has demonstrated its positive outcomes. The research shows that SBIRT is an effective way to reduce drinking and substance abuse problems. 31

32 Brief interventions Are low cost and effective Research Shows Are most effective among persons with less severe problems Brief interventions are feasible and highly effective components of an overall public health approach to reducing alcohol misuse. (Whitlock et al., 2004, for U.S. Preventive Services Task Force) 32

33 Strong Research and Substantial Experiential Evidence Supports the Model There is substantial evidence for the effectiveness of brief interventions for harmful drinking. There is a growing body of literature showing the effectiveness of SBIRT for risky drug use. SAMHSA Whitepaper, 2011 ( 33

34 Making a Measurable Difference Since 2003, Substance Abuse and Mental Health Services Administrations (SAMHSA) has supported SBIRT programs, with more than 1.5 million persons screened. Outcome data confirm a 40 percent reduction in harmful use of alcohol by those drinking at risky levels and a 55 percent reduction in negative social consequences. Outcome data also demonstrate positive benefits for reduced illicit substance use. Based on review of SBIRT GPRA data ( ) 34

35 SBIRT Is a Highly Flexible Intervention SBIRT Settings Aging/Senior Services Inpatient Behavioral Health Clinic Primary Care Clinic Community Health Center Psychiatric Clinic Community Mental Health Center School-Based/Student Health Drug Abuse/Addiction Services Trauma Centers/Trauma Units Emergency Room Urgent Care Federally Qualified Health Center Veterans Hospital Homeless Facility Other Agency Sites Hospital 35

36 Why Is SBIRT Important for Advanced Practice Nurses? 36

37 SBIRT Reduces Short - and Long- Term Health Care Costs By intervening early, SBIRT saves lives and money and is consistent with overall support for patient wellness. Late-stage intervention and substance abuse treatment is expensive, and the patient has often developed comorbid health conditions. 37

38 SBIRT Decreases the Frequency and Severity of Alcohol and Drug Use Primary care is one of the most convenient points of contact for substance issues. Many patients are more likely to discuss this subject with their health care provider than a relative, therapist, or rehab specialist. 38

39 Coding & Billing SBIRT services are reimbursable Our protocols should ensure that services are documented and billed 39

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41 Lessons Learned SBIRT is a brief and highly adaptive evidence-based practice with demonstrated results. SBIRT has been successfully implemented in diverse sites across the life span. Patients are open to talking with trusted helpers about substance use. SBIRT makes good clinical and financial sense. 41

42 Questions