Abstract
Background/Aims The US Preventive Services Task Force has identified alcohol and drug use screening as a high priority in primary care. SBIRT is a framework for population based screening and brief intervention with the goal of reducing substance use before it progresses to dependence. There has been limited uptake of SBIRT in any large health system, thus SAMHSA has supported a series of studies, led by Kaiser Permanente Colorado (KPCO), to determine strategies to promote large scale SBIRT implementation.
Methods A qualitative examination of SBIRT feasibility and subsequent pilot testing within KPCO primary care guided a series of additional stakeholder interviews at Henry Ford Health System (HFHS) to assess feasibility of SBIRT implementation in additional organizations. Qualitative interviews were conducted with a broad spectrum of HFHS stakeholders using snowball sampling. A total of 28 HFHS stakeholders were interviewed. Interviews were conducted telephonically by trained interviewers from KPCO and lasted approximately 30 minutes. Interviews were digitally recorded and transcribed. After each interview, a detailed summary was generated and used to create the initial code book for analysis of interview transcripts.
Results While current screening, brief intervention, and referral to treatment processes for substance use were noted in HFHS, they were inconsistent and no systematic policies exist. Many facilitators for SBIRT implementation within HFHS were noted including: population, recent implementation of depression screening in primary care, and EMR tools to facilitate documentation. Barriers to SBIRT implementation included time and competing demands for primary care providers, access to treatment, and follow-up processes for positive screens. All stakeholders were supportive of pilot implementation of SBIRT within HFHS with adequate attention to barriers and facilitators.
Conclusions This project successfully demonstrated the value of gaining stakeholder perspectives in order to facilitate successful implementation of SBIRT in large integrated health systems and provides a systematic protocol for gathering this data.
