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Screening and brief intervention (SBI) for alcohol and other drug problems can be effectively implemented in community hospitals if certain barriers are addressed and overcome, according to researchers at Rhode Island Hospital.
Most past research on SBI has been conducted in academic medical facilities, but more than half of all visits to emergency-rooms — the primary nexus for SBI — take place in community hospitals. Researcher Michael Mello, M.D., and colleagues, using feedback from emergency-department staff, developed, implemented and evaluated a model SBI program for community hospitals.
“Our research identified numerous barriers, with key stakeholders expressing concern over potential disruption to the clinical practice and patient flow; the burden of SBI on staff time, particularly nurses; the willingness of nursing and physician staff to accept the SBI; and staff reluctance to speak to patients about alcohol-related issues when not directly related to a patient's chief complaint,” said Mello.
In response, the SBI model was limited to an area of the emergency department for non-critical patients, with only physicians allowed to use the screening tool. Doctors would then refer patients who screened positive for alcohol or other drug problems to a research assistant who would perform the brief intervention.
Researchers found that screening increased significantly under the model, but fell again after the research assistant was removed from the ER. Mello said that the study showed that “with the appropriate training and tools, combined with additional resources devoted to this effort, SBI can be successfully transitioned and integrated into community hospital emergency departments. Additional research would help to further refine the SBI model so that it would work in different types of community hospitals.”
“In the end, if the identified barriers can be overcome, we believe that a refined model will result in higher levels of screening for alcohol problems and appropriate referrals for help with many patients,” he added.
The study was published in the August 2009 issue of the journal Substance Abuse.