- Email: [email protected]
Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in
American Journal of Emergency Medicine xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in To the Editor, An average of 87 798 alcohol-attributable deaths and 2 560 290 years of potential life lost occurred in the United States annually from 2006 to 2010 [1]. In 2010, alcohol abuse cost the United States $249 billion [2]. Numerous studies over the past 50 years demonstrate the effect of brief screening and intervention on improving follow-up for substance abuse treatment and decreasing future substance abuse. The screening, brief intervention, and referral to treatment (SBIRT) technique has been studied since the 1960s as a way to address the risky behavior of patients who present to health care due to causes either directly or indirectly related to alcohol and substance abuse [3,4]. Studies have consistently shown that SBIRT provided in a health care setting can increase the likelihood of patient follow-up for further treatment for alcohol and substance misuse and can significantly decrease future substance abuse. One study demonstrated up to 67.7% decreases in drug abuse and 38.6% decreases in alcohol use at some sites [5]. The emergency department (ED) is a prime location to implement SBIRT due to a high volume of patients presenting with alcohol and substance abuse risk factors as well as related illnesses and injuries [6]. There are numerous studies that demonstrate the positive impact of SBIRT on patients in EDs [7-10]; however, there is a dearth of literature on staff attitudes regarding SBIRT adoption into practice in ED settings. In 2007, an SBIRT program began at Denver Health Medical Center, an academic inner city safety net hospital. This program aims to identify at-risk patients in the ED and the adult urgent care clinic. We conducted 2 serial observational, cross-sectional, self-administered staff surveys 5 years apart. The first one was completed in 2009 [11]; and the second one, in 2014. The results were compared for longitudinal changes. These studies were completed using Survey Monkey which was delivered via e-mail to the participants. The survey tool included 19 items with predominately closed responses and Likert scales and took approximately 5 minutes to complete. The surveys included questions on each participant's specific role/title, area of clinical practice, duration of practice, knowledge of SBIRT, frequency of utilization, perceived importance of SBIRT, and suggestions for improvement. These studies were approved by the Colorado Multiple Institutional Review Board. The clinical areas included in the studies were the ED at Medical Center and the adult urgent care clinic. Participants in the study were Denver Health care providers (physicians, physician assistants, residents, nurses, nurse practitioners). The 2014 study results in comparison to the 2009 study had an overall smaller study population of 193 compared to 235. Response rates were also less than 66% to 74%, respectively. The 2014 study demonstrated a 9% increase in female provider respondents with slightly less providers
with greater than 10 years of experience. Similar response rates from both clinical areas were observed for both studies (Table 1). Participants in the 2014 survey compared to participants in the 2009 survey reported a significantly higher level of perceived importance of SBIRT in their practice (77%-57%) and to the health of their patient (87%-71%). Significantly more providers felt that it was both easy to very easy to incorporate it into their practice (61%-40%) with 12% more (83%-71%) feeling they should be incorporating SBIRT into their practice. Several other metrics in the study demonstrated trends toward improvements in comfort with SBIRT, daily utilization of SBIRT, and perceptions of effect of SBIRT, but none reached statistical significance (Table 2). Although there is some literature which looks at short-term changes in practitioner attitudes, there have been no studies that examine longterm (N1 year) attitudes after an SBIRT program implementation. Most studies examine before and after implementation in a short-term period, as in 3 months or less, and most are in the nursing literature. Comparing interval change is important to assess staff educational needs as well as attitude change. Our 2014 survey study results are encouraging in that a significant number of providers 77% perceive SBIRT to be of importance to their practice; 81% think it to be important to their patients' health, and 83% feel that they should incorporate it into their practice. Staff acceptance of SBIRT is extremely important to the sustainability of both the program and the quality of care that patients receive while seeking emergent and urgent care. To our knowledge, this is the only longitudinal study of staff attitudes and acceptance of SBIRT across multiple years in an emergent and urgent care setting. These results indicate that we are making a positive difference in clinician attitudes toward providing SBIRT to our patients. If we are to continue to improve the use of SBIRT universally in health care, we need to engage staff in use and importance in our patient's health. Bonnie Kaplan MD1 University of Colorado at Denver, Aurora, CO 80045 E-mail address: [email protected] Emily Hopkins MSPH2 Denver Health Medical Center, Denver, CO 80204 E-mail address: [email protected] Matthew Taecker MD3 Benefits Hospital, Great Falls, MT E-mail address: [email protected] 1
Tel.: +1 847 477 2856. Tel.: +1 303 602 5178. Tel.: +1 605 680 9383.
2 3
0735-6757/© 2016 Published by Elsevier Inc.
Please cite this article as: Kaplan B, et al, Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.08.012
2
Correspondence / American Journal of Emergency Medicine xxx (2016) xxx–xxx
Table 1 Participant demographics
Clinical location Adult ED Adult urgent care center Job category Resident Attending Nurse Advanced care provider Sex Male Female Years of experience b1 1-3 3-10 N10
2009 survey, n = 173
2014 survey, n = 127
n
% (95% CI)
n
% (95% CI)
146 27
84 (78-89) 16 (11-22)
107 20
84 (77-90) 16 (10-23)
40 31 92 10
23 (17-30) 18 (13-24) 53 (45-61) 6 (3-10)
36 24 61 6
28 (21-37) 19 (12-27) 48 (39-57) 5 (2-10)
57 114
33 (26-40) 66 (58-73)
53 73
42 (33-51) 58 (45-66)
4 31 72 65
2 (1-6) 18 (13-24) 42 (34-49) 38 (30-45)
1 26 57 43
1 (0-4) 20 (14-29) 45 (36-54) 34 (26-43)
Abbreviation: CI, confidence interval.
Kerryann B. Broderick BSN, MD Denver Health Medical Center, Denver, CO 80204 Corresponding author. Tel.: +1 303 602 5189; fax: +1 303 602 5171 E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.08.012
References [1] Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis 2014;11, E109. http://dx.doi.org/10.5888/pcd11.130293. [2] Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med 2015;49(5): e73–9 [PMID: 26477807]. [3] D'Onofrio G, Pantalon MV, Degutis LC, O'Connor PG. Development and implementation of an emergency department practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department. Acad Emerg Med 2005; 12(3):249–56. [4] Saitz RM. Screening and brief intervention enter their 5th decade. Subst Abus 2007; 28(3):3–6.
Table 2 Participant responses Responses
How comfortable are you with your knowledge about SBIRT?
How comfortable are you with your knowledge about the brief conversation?
How do you rate the ease of integrating SBIRT into your practice?
How important do you feel SBIRT is in your practice?
How important do you feel SBIRT is for the health of each patient?
How often do you talk to your patients about substance use/abuse?
Do you know where to find the brief screen results on the chart?
Do you know where to find the “Brief Conversation” area for documentation on the chart? How often are you documenting your “Brief Conversation” with the patients regarding substance abuse? I need additional training on the Brief screen
I need additional training on the brief conversation.
I should be doing substance screening and the “Brief Conversation” in my clinical practice. Talking to patients about substance use/abuse makes a difference.
I think substance screening is important in my clinical practice.
I see value added to patients by the SBIRT health educator.
a
Very comfortable/comfortable Neither comfortable nor uncomfortable Uncomfortable/very uncomfortable Very comfortable/comfortable Neither comfortable nor uncomfortable Uncomfortable/very uncomfortable Very easy/easy Neither easy nor difficult Difficult/very difficult Very important/important Neither important nor unimportant Unimportant/very unimportant Very important/important Neither important nor unimportant Unimportant/very unimportant Always/most of the time About half of the time Rarely/never Yes Kind of No Yes Kind of No Always/most of the time About half of the time Rarely/never No Yes Administering Documenting Interpreting All of the above Strongly agree/agree Neither agree nor disagree Disagree/strongly Disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree
2014, n = 127
2009, n = 173
n
% (95% CI)
n
% (95% CI)
87 28 10 79 34 14 78 31 17 98 21 6 111 12 3 73 40 12 57 34 34 95 22 8 28 20 77 82 42
69 (60-76) 22 (15-30) 8 (4-14) 62 (53-71) 27 (19-36) 11 (6-18) 61 (52-70)a 24 (17-33) 13 (8-21) 77 (69-84)a 17 (11-24) 5 (2-10) 87 (80-93)a 9 (5-16) 2 (0-7) 57 (48-66) 32 (24-40) 9 (6-16) 45 (36-54) 27 (19-35) 27 (19-35) 75 (66-82) 17 (11-25) 6 (3-12) 22 (15-30) 16 (10-23) 61 (52-69) 65 (56-73) 33 (25-42)
115 47 9 104 39 29 70 60 40 99 53 18 123 31 14 94 55 21 111 42 17 65 60 46 46 36 90
66 (59-73) 27 (21-34) 5 (2-10) 60 (52-67) 22 (17-30) 17 (12-23) 40 (33-48)a 35 (28-42) 23 (17-30) 57 (49-65)a 31 (24-38) 10 (6-16) 71 (34-78)a 18 (13-24) 8 (4-13) 54 (47-62) 32 (25-39) 12 (8-18) 64 (57-71) 24 (18-31) 10 (6-15) 37 (30-45) 35 (28-42) 27 (20-34) 27 (20-34) 21 (15-28) 52 (44-60)
4 23 2 44 73 33 65 110 34 27 110 44 19 123 33 15
2 (0-4) 13 (9-19) 1 (0-4) 25 (10-21) 42 (35-50) 19 (14-26) 38 (30-45) 64 (56-71) 20 (14-26) 16 (11-22) 64 (56-71) 25 (19-33) 11 (7-17) 71 (34-78)a 19 (14-26) 9 (5-14)
62 28 35 85 34 5 85 29 11 106 17 4 103 19 4
49 (40-58) 22 (15-30) 28 (20-36) 67 (58-75) 27 (19-35) 4 (1-9) 67 (58-75) 23 (16-31) 9 (4-15) 83 (76-89)a 13 (8-21) 3 (1-8) 81 (73-88) 15 (9-22) 3 (1-8)
Significant confidence intervals.
Please cite this article as: Kaplan B, et al, Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.08.012
Correspondence / American Journal of Emergency Medicine xxx (2016) xxx–xxx [5] Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple health care sites: comparison at intake and 6 months later. Drug Alcohol Depend 2009;99(1–3):280–95. http://dx.doi.org/10.1016/j. drugalcdep.2008.08.003. [6] Babor TF, McGee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus 2007;28(3): 7–30. [7] D'Onofrio G, Fiellin DA, Pantalon MV, Chawarski MC, Owens PH, Degutis LC, et al. A brief intervention reduces hazardous and harmful drinking in the emergency department. Ann Emerg Med 2012;60(2):181–92.
3
[8] Bernstein SL, Bijur P, Cooperman N, Jerald S, Arnseten JH, Moadel A, et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Emerg Med 2011;18(6):575–83. [9] Academic ED. SBIRT Research Collaborative. An evidence-based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department providers improves skills and utilization. Subst Abus 2007;28(4):79–92. [10] Woolard R, Baird J, Longabaugh R, Nirenberg T, Lee CS, Mello MJ, et al. Project Reduce: reducing alcohol and marijuana misuse: effects of a brief intervention in the emergency department. Addict Behav 2013;38(3):1732–9. [11] Kaplan B, Broderick K. Interviewing the interviewers: the SBIRT program at Denver Health. Subst Abus 2011;32(1):70–1 [https://amersa.org/wp-content/uploads/ 2015/03/2009_Program_Brochure.pdf].
Please cite this article as: Kaplan B, et al, Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.08.012
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in To the Editor, An average of 87 798 alcohol-attributable deaths and 2 560 290 years of potential life lost occurred in the United States annually from 2006 to 2010 [1]. In 2010, alcohol abuse cost the United States $249 billion [2]. Numerous studies over the past 50 years demonstrate the effect of brief screening and intervention on improving follow-up for substance abuse treatment and decreasing future substance abuse. The screening, brief intervention, and referral to treatment (SBIRT) technique has been studied since the 1960s as a way to address the risky behavior of patients who present to health care due to causes either directly or indirectly related to alcohol and substance abuse [3,4]. Studies have consistently shown that SBIRT provided in a health care setting can increase the likelihood of patient follow-up for further treatment for alcohol and substance misuse and can significantly decrease future substance abuse. One study demonstrated up to 67.7% decreases in drug abuse and 38.6% decreases in alcohol use at some sites [5]. The emergency department (ED) is a prime location to implement SBIRT due to a high volume of patients presenting with alcohol and substance abuse risk factors as well as related illnesses and injuries [6]. There are numerous studies that demonstrate the positive impact of SBIRT on patients in EDs [7-10]; however, there is a dearth of literature on staff attitudes regarding SBIRT adoption into practice in ED settings. In 2007, an SBIRT program began at Denver Health Medical Center, an academic inner city safety net hospital. This program aims to identify at-risk patients in the ED and the adult urgent care clinic. We conducted 2 serial observational, cross-sectional, self-administered staff surveys 5 years apart. The first one was completed in 2009 [11]; and the second one, in 2014. The results were compared for longitudinal changes. These studies were completed using Survey Monkey which was delivered via e-mail to the participants. The survey tool included 19 items with predominately closed responses and Likert scales and took approximately 5 minutes to complete. The surveys included questions on each participant's specific role/title, area of clinical practice, duration of practice, knowledge of SBIRT, frequency of utilization, perceived importance of SBIRT, and suggestions for improvement. These studies were approved by the Colorado Multiple Institutional Review Board. The clinical areas included in the studies were the ED at Medical Center and the adult urgent care clinic. Participants in the study were Denver Health care providers (physicians, physician assistants, residents, nurses, nurse practitioners). The 2014 study results in comparison to the 2009 study had an overall smaller study population of 193 compared to 235. Response rates were also less than 66% to 74%, respectively. The 2014 study demonstrated a 9% increase in female provider respondents with slightly less providers
with greater than 10 years of experience. Similar response rates from both clinical areas were observed for both studies (Table 1). Participants in the 2014 survey compared to participants in the 2009 survey reported a significantly higher level of perceived importance of SBIRT in their practice (77%-57%) and to the health of their patient (87%-71%). Significantly more providers felt that it was both easy to very easy to incorporate it into their practice (61%-40%) with 12% more (83%-71%) feeling they should be incorporating SBIRT into their practice. Several other metrics in the study demonstrated trends toward improvements in comfort with SBIRT, daily utilization of SBIRT, and perceptions of effect of SBIRT, but none reached statistical significance (Table 2). Although there is some literature which looks at short-term changes in practitioner attitudes, there have been no studies that examine longterm (N1 year) attitudes after an SBIRT program implementation. Most studies examine before and after implementation in a short-term period, as in 3 months or less, and most are in the nursing literature. Comparing interval change is important to assess staff educational needs as well as attitude change. Our 2014 survey study results are encouraging in that a significant number of providers 77% perceive SBIRT to be of importance to their practice; 81% think it to be important to their patients' health, and 83% feel that they should incorporate it into their practice. Staff acceptance of SBIRT is extremely important to the sustainability of both the program and the quality of care that patients receive while seeking emergent and urgent care. To our knowledge, this is the only longitudinal study of staff attitudes and acceptance of SBIRT across multiple years in an emergent and urgent care setting. These results indicate that we are making a positive difference in clinician attitudes toward providing SBIRT to our patients. If we are to continue to improve the use of SBIRT universally in health care, we need to engage staff in use and importance in our patient's health. Bonnie Kaplan MD1 University of Colorado at Denver, Aurora, CO 80045 E-mail address: [email protected] Emily Hopkins MSPH2 Denver Health Medical Center, Denver, CO 80204 E-mail address: [email protected] Matthew Taecker MD3 Benefits Hospital, Great Falls, MT E-mail address: [email protected] 1
Tel.: +1 847 477 2856. Tel.: +1 303 602 5178. Tel.: +1 605 680 9383.
2 3
0735-6757/© 2016 Published by Elsevier Inc.
Please cite this article as: Kaplan B, et al, Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.08.012
2
Correspondence / American Journal of Emergency Medicine xxx (2016) xxx–xxx
Table 1 Participant demographics
Clinical location Adult ED Adult urgent care center Job category Resident Attending Nurse Advanced care provider Sex Male Female Years of experience b1 1-3 3-10 N10
2009 survey, n = 173
2014 survey, n = 127
n
% (95% CI)
n
% (95% CI)
146 27
84 (78-89) 16 (11-22)
107 20
84 (77-90) 16 (10-23)
40 31 92 10
23 (17-30) 18 (13-24) 53 (45-61) 6 (3-10)
36 24 61 6
28 (21-37) 19 (12-27) 48 (39-57) 5 (2-10)
57 114
33 (26-40) 66 (58-73)
53 73
42 (33-51) 58 (45-66)
4 31 72 65
2 (1-6) 18 (13-24) 42 (34-49) 38 (30-45)
1 26 57 43
1 (0-4) 20 (14-29) 45 (36-54) 34 (26-43)
Abbreviation: CI, confidence interval.
Kerryann B. Broderick BSN, MD Denver Health Medical Center, Denver, CO 80204 Corresponding author. Tel.: +1 303 602 5189; fax: +1 303 602 5171 E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.08.012
References [1] Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis 2014;11, E109. http://dx.doi.org/10.5888/pcd11.130293. [2] Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med 2015;49(5): e73–9 [PMID: 26477807]. [3] D'Onofrio G, Pantalon MV, Degutis LC, O'Connor PG. Development and implementation of an emergency department practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department. Acad Emerg Med 2005; 12(3):249–56. [4] Saitz RM. Screening and brief intervention enter their 5th decade. Subst Abus 2007; 28(3):3–6.
Table 2 Participant responses Responses
How comfortable are you with your knowledge about SBIRT?
How comfortable are you with your knowledge about the brief conversation?
How do you rate the ease of integrating SBIRT into your practice?
How important do you feel SBIRT is in your practice?
How important do you feel SBIRT is for the health of each patient?
How often do you talk to your patients about substance use/abuse?
Do you know where to find the brief screen results on the chart?
Do you know where to find the “Brief Conversation” area for documentation on the chart? How often are you documenting your “Brief Conversation” with the patients regarding substance abuse? I need additional training on the Brief screen
I need additional training on the brief conversation.
I should be doing substance screening and the “Brief Conversation” in my clinical practice. Talking to patients about substance use/abuse makes a difference.
I think substance screening is important in my clinical practice.
I see value added to patients by the SBIRT health educator.
a
Very comfortable/comfortable Neither comfortable nor uncomfortable Uncomfortable/very uncomfortable Very comfortable/comfortable Neither comfortable nor uncomfortable Uncomfortable/very uncomfortable Very easy/easy Neither easy nor difficult Difficult/very difficult Very important/important Neither important nor unimportant Unimportant/very unimportant Very important/important Neither important nor unimportant Unimportant/very unimportant Always/most of the time About half of the time Rarely/never Yes Kind of No Yes Kind of No Always/most of the time About half of the time Rarely/never No Yes Administering Documenting Interpreting All of the above Strongly agree/agree Neither agree nor disagree Disagree/strongly Disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree
2014, n = 127
2009, n = 173
n
% (95% CI)
n
% (95% CI)
87 28 10 79 34 14 78 31 17 98 21 6 111 12 3 73 40 12 57 34 34 95 22 8 28 20 77 82 42
69 (60-76) 22 (15-30) 8 (4-14) 62 (53-71) 27 (19-36) 11 (6-18) 61 (52-70)a 24 (17-33) 13 (8-21) 77 (69-84)a 17 (11-24) 5 (2-10) 87 (80-93)a 9 (5-16) 2 (0-7) 57 (48-66) 32 (24-40) 9 (6-16) 45 (36-54) 27 (19-35) 27 (19-35) 75 (66-82) 17 (11-25) 6 (3-12) 22 (15-30) 16 (10-23) 61 (52-69) 65 (56-73) 33 (25-42)
115 47 9 104 39 29 70 60 40 99 53 18 123 31 14 94 55 21 111 42 17 65 60 46 46 36 90
66 (59-73) 27 (21-34) 5 (2-10) 60 (52-67) 22 (17-30) 17 (12-23) 40 (33-48)a 35 (28-42) 23 (17-30) 57 (49-65)a 31 (24-38) 10 (6-16) 71 (34-78)a 18 (13-24) 8 (4-13) 54 (47-62) 32 (25-39) 12 (8-18) 64 (57-71) 24 (18-31) 10 (6-15) 37 (30-45) 35 (28-42) 27 (20-34) 27 (20-34) 21 (15-28) 52 (44-60)
4 23 2 44 73 33 65 110 34 27 110 44 19 123 33 15
2 (0-4) 13 (9-19) 1 (0-4) 25 (10-21) 42 (35-50) 19 (14-26) 38 (30-45) 64 (56-71) 20 (14-26) 16 (11-22) 64 (56-71) 25 (19-33) 11 (7-17) 71 (34-78)a 19 (14-26) 9 (5-14)
62 28 35 85 34 5 85 29 11 106 17 4 103 19 4
49 (40-58) 22 (15-30) 28 (20-36) 67 (58-75) 27 (19-35) 4 (1-9) 67 (58-75) 23 (16-31) 9 (4-15) 83 (76-89)a 13 (8-21) 3 (1-8) 81 (73-88) 15 (9-22) 3 (1-8)
Significant confidence intervals.
Please cite this article as: Kaplan B, et al, Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.08.012
Correspondence / American Journal of Emergency Medicine xxx (2016) xxx–xxx [5] Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple health care sites: comparison at intake and 6 months later. Drug Alcohol Depend 2009;99(1–3):280–95. http://dx.doi.org/10.1016/j. drugalcdep.2008.08.003. [6] Babor TF, McGee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus 2007;28(3): 7–30. [7] D'Onofrio G, Fiellin DA, Pantalon MV, Chawarski MC, Owens PH, Degutis LC, et al. A brief intervention reduces hazardous and harmful drinking in the emergency department. Ann Emerg Med 2012;60(2):181–92.
3
[8] Bernstein SL, Bijur P, Cooperman N, Jerald S, Arnseten JH, Moadel A, et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Emerg Med 2011;18(6):575–83. [9] Academic ED. SBIRT Research Collaborative. An evidence-based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department providers improves skills and utilization. Subst Abus 2007;28(4):79–92. [10] Woolard R, Baird J, Longabaugh R, Nirenberg T, Lee CS, Mello MJ, et al. Project Reduce: reducing alcohol and marijuana misuse: effects of a brief intervention in the emergency department. Addict Behav 2013;38(3):1732–9. [11] Kaplan B, Broderick K. Interviewing the interviewers: the SBIRT program at Denver Health. Subst Abus 2011;32(1):70–1 [https://amersa.org/wp-content/uploads/ 2015/03/2009_Program_Brochure.pdf].
Please cite this article as: Kaplan B, et al, Screening, brief intervention, and referral to treatment: a 5-year comparison of staff buy-in, Am J Emerg Med (2016), http://dx.doi.org/10.1016/j.ajem.2016.08.012