SBIRT Implementation in Primary Care Practice
Nohamin Ayele M1, Renzo Costa M1, Alexandra Dereix M1, Sayeeda Kausar MSW2, Sucheta Korwar M1, Suzana Nikitovic BSN
RN, Alma Ramirez MSW2, Kaitlyn Taylor MS NDTR, Maria Thaiveettil MSN RN, John Orwat PhD
Loyola University Chicago
Abstract
This project examines the use of and challenges associated
with the SBIRT (Screening, Brief Intervention, and Referral to
Treatment) model at the family medicine clinic at Loyola
Center for Health at Elmwood Park.
Introduction
• SBIRT is an evidence-based tool to explore substance use
with patients and improve health outcomes by eliciting
personal motivation for behavior change.
• SBIRT is in use at the family medicine clinic at Loyola
Center for Health at Elmwood Park, which provides
primary care to patients from infancy to old age, from
communities such as Maywood, Bellwood, Oak Park, River
Park, and South Side Chicago.
• Risk factors for substance abuse align with social
determinants of health such as income level and
employment status. Maywood has one of the highest
numbers of ED visits for substance abuse in suburban Cook
County (1).
Clinical use of SBIRT
• Started use 3 years ago
• Initial screening given to patients at family medicine clinic,
once a year at front desk, usually with depression screen
• Scoring and behavioral intervention, if needed, done by
doctors or APN
• If needed, referral to social worker or a treatment site
from a compiled resources list
Techniques
• Patients are first given a general screening tool (Figure 1) that tests for
Depression, TAPS, and Fall Risk once a year as a part of their standard of
care.
• If they test positive in the TAPS segment, they are flagged by the clinic’s
front desk/nursing staff so that the provider can further screen them,
using a more specific tool such as the US AUDIT(Alcohol Use Disorder
Identification Test) and/or DAST(Drug Abuse Screening Test) (Figure 2)
• Once the patient has been further screened, the provider performs a
brief intervention utilizing strategies to actively engage the patient and
assess their readiness for change (Figure 3)
Figure 1 Figure 2
Figure 3
Images provided by Suzana Nikitovic BSN RN
Challenges to Implementation
• Processing patients through SBIRT i.e who was assigned the task of
giving the screening, performing the Brief Negotiating Interview,
transitioning the patient through a referral. Getting raw data on
whether or not this is working; everything is dug up in the clinical
notes
• Time needed to charge and track records in EPIC; not a very clear way
to organize and refer back to records for billing
• Extracting clean and raw data from EPIC
• No clear way to follow-up with patients after they have been referred
Literature Review
Several studies highlight the need for reliable data
collection of SBIRT effectiveness on a nationwide level.
Research on collecting data at the individual clinic level was
scarce. A cross comparison of different SBIRT programs
between 2004-2014 found difficulties in assessing the overall
success of SBIRT because of variability in implementing SBIRT
amongst the programs (2).
The National Institute on Drug Abuse Center for the
Clinical Trials Network and National Cancer Institute is
developing a performance measure for substance use
screening in primary care settings. This measure would
provide a report on the number of screened adults, the
number of positive results, and the number of people who
received brief counseling, but would not report on the
patients who received referrals to treatment, or the patient’s
status post-referral (3).
At the level of the electronic health record, studies note
that changes in the configuration of the record may help with
data collection. One advocates for the development of
Common Data Elements (CDEs) which are defined as data
that can be used and extracted from different electronic
health record platforms (4). This would allow for broader
data collection, across clinics nationwide.
Conclusion
Because of the variability of the implementation of SBIRT
across settings, tracking its effectiveness has proven to be
challenging. National organizations and electronic health
record developers are working towards standardizing and
collecting national data, but research on how to help
individual clinics such as Loyola at Elmwood Park collect their
data is scarce. SBIRT remains an evidence-based tool, with
just a 5 minute intervention reducing risky substance use and
reducing health related diseases and consequences related to
risky substance use.
References
1 Community Health Needs Assessment: Central Region. Cook County: Illinois Public Health
Institute, 2016. https://www.loyolamedicine.org/sites/default/files/community-health-
needs-assessment-june2016
2. Reho, K., Agley, J., DeSalle, M. et al. J Primary Prevent (2016). Are We There Yet? A
Review of Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Implementation Fidelity Tools and Proficiency Checklists. 37: 377.
https://doi.org/10.1007/s10935-016-0431-x
3. Ghitza, U. E., & Tai, B. (2014). Challenges and opportunities for integrating preventive
substance-use-care services in primary care through the Affordable Care Act. Journal of
health care for the poor and underserved, 25(1 Suppl), 36–45. doi:10.1353/hpu.2014.0067
4. Tai, B., Wu, L. T., & Clark, H. W. (2012). Electronic health records: essential tools in
integrating substance abuse treatment with primary care. Substance abuse and
rehabilitation, 3, 1–8. doi:10.2147/SAR.S22575