Transcription
tervention JulieWorley,PhD,FNP,PMHNP KathyDelaney,PhD,PMHNP,FAAN
wareness- cialtycareforpatientswithsubstanceusedisorders
NursesandSBIRT nurses. euseisdetectedonscreening. mentorrefertotreatmentasindicated.
ofSettingsSBIRTSettingsAging/Senior ServicesInpatientBehavioral Health ClinicPrimary Care ClinicCommunity Health CenterPsychiatric ClinicCommunity Mental Health CenterSchool-Based/Student HealthDrug Abuse/Addiction ServicesTrauma Centers/Trauma UnitsEmergency RoomUrgent CareFederally Qualified Health CenterVeterans HospitalHomeless FacilityOther Agency SitesHospital
MedicalSpecialtyAreas
SBIRTaimsto srelatedtotheirsubstanceuse.
spective
Evidenceindicatesthatmoderate- ‐riskandhigh- ‐riskdrinkersaccountforthemostproblems
WhyIsSBIRTImportant? deathseachyear. Thecoststosocietyaremorethan 600billionannually. r- kplace,community,andthehealthcaresystem. similarrelapseratesasdiabetesandhypertension
WhyUseSBIRT? resubstanceuseproblems SBIRTassertsthattreatmentforat- e ndatedinhealthcaresettings
MissedOpportunitiesMostpatients(68- yhealthcareprofessionals. lproblems: Whenscreeningtoolsarenotuseduniversally Whites,women,andthoseofhigherSESAdapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org)
SBIRTReducesShort- ‐andLong- ‐TermHealthCareCosts sistentwithoverallsupportforpatientwellness. Late- thconditions.
EffectivenessofSBIRTMeta- ‐analysesandReviews Morethen34randomizedcontrolledtrials Focusedmainlyonat- ‐riskandproblemdrinkers.Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org)
ontactforsubstanceissues. orrehabspecialist.
raskedmehowmuchalcoholIdrink.”78%Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org)
MakingaMeasurableDifference than1.5millionpersonsscreened. eductioninnegativesocialconsequences. (2003 2011)
MakingtheTransitiontoSBIRT Routineanduniversalscreening Validatedscreeningtools AUDITandDAST ionaldichotomousview) Patient- ing) MotivationalInterviewingAdaptedfromThe OregonSBIRT PrimaryCare Residency Initiative training curriculum (www.sbirtoregon.org)
llnessscreenwithimbeddedsinglequestionpre- ‐screens.
.,Schmidt,S.M.,Allensworth- ofasingle- ,783 788
eklyaverage daysXdrinksRecommendedLimitsMen 2perday/14perweekWomen/anyone65 1perdayor7drinksperweek Regularlimits at- ‐riskdrinker
PositiveAlcoholScreen At- ‐RiskDrinkerBinge drink( 5 for men or 4 for women/anyone 65 )Or patient exceeds regular limits?(Men: 2/day or 14/weekWomen/anyone 65 : 1/day or antalcoholimpairmentusingAUDIT.
WhenScreening,It’sUsefulToClarifyWhatOneDrinkIs!
HowMuchIs“OneDrink”?
nfornonmedicalreasons?”( syouhave t,S.M.,Allensworth- ‐Davies,D.,&Saitz,R.(2010).Asingle- chInternMed,170(13),1155 1160.
estionputsthepatientinan“at- tity.Askaboutnegativeimpacts.
ernedwithcontrolleddrugs— teSleepaids(zolpidem,zaleplon,eszopicione)
oomandthenreviewsthescreen. Positive? PatientaskedtocompleteAUDITand/orDASTNegative? Nofurtheractivity
t? Tenquestions,self- talcoholuse,alcoholdependencesymptoms,andalcohol- ‐relatedproblems DevelopedbyWorldHealthOrganization(WHO)
DAST(10)Whatisit? ng10items,completedasself- gquestionsforat- n,nowtheCenterforAddictionandMentalHealth
KeyPointsforScreening Screeneveryone. ugabuseandtobacco. Useavalidatedtool. ssurvey. lbehaviorsduringscreening. Exploreeachsubstance;manypatientsusemorethanone.
tochangeanddecreasedefensiveness
ssedtheresultsofthescreeningyou;illedouttoday?” Askingpermissionmakesitacollaborativeprocess.
oyoufeelaboutyouralcohol(ordrug)use?” Providingfeedbackcanbeusedto ddressinguseatlaterassessmentsElicitingaresponse: thepatientfeelsdefensive
”
rlifepotentiallychangeand/orimprove?”
sbecomeproblematic?”
ughyourpracticeorreferraltoanothertreatmentprogram
nthefuture?”
LessonsLearned SBIRTisabriefandhighlyadaptiveevidence- ‐basedpracticewithdemonstratedresults. crossthelifespan. stanceuse. SBIRTmakesgoodclinicalandHinancialsense.
Questions?
ith,P.C.,Schmidt,S.M.,Allensworth- ‐Davies,D.,&Saitz,R.(2010).Asingle- chInternMed,170(13),1155 ville,MD:SAMHSA
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
