Abstract
Background/Aims Screening for alcohol and drug use has been identified as a high prevention priority for primary care by the US Preventive Services Task force; however, such screening is not routinely performed. SBIRT is a framework for population-based screening and intervention with the primary goal of reducing risky substance use before it progresses to dependence. There has been limited uptake of SBIRT in any large health system, thus the Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting a series of studies, led by Kaiser Permanente Colorado (KPCO), to determine strategies to promote large-scale implementation. Qualitative examination of the feasibility of implementing SBIRT in primary care settings was previously conducted at KPCO; a continuation of this work at Henry Ford (HF) and Lovelace Health System (LHS) is currently being conducted.
Methods Individual interviews and focus groups will use selective and snowball sampling of clinical leaders and staff, with the goal to assess value placed on systematized substance use screening in primary care, feasibility of implementing SBIRT, potential barriers, solutions, and facilitators to implementation, and strategies for gaining stakeholder support. Episodic profiles or debriefing reports will be generated shortly after every interview with leaders and staff at LHS and HF to facilitate iterative analysis.
Results Qualitative findings from KPCO indicated the following key influencers: scope of practice, particularly for nurses, medical assistants and front desk staff; competing priorities for primary care physicians; and relationships between primary care, behavioral health, and chemical dependency departments. Interviews to be completed at LHS and HF will assess general feasibility as well as investigate whether KPCO’s findings generalize to other health systems. Additionally, interviews will focus on the impact of patient cultural differences for SBIRT, where HF, LHS, and KPCO have distinct racial and ethnic patient populations.
Conclusions The goal is to provide a more comprehensive understanding of the facilitators and barriers to SBIRT implementation across multiple health systems.
