Implementation of SBIRT Services for Individuals with Substance Use Disorder in Urgent Care

Abstract

Background Statistics indicate that nearly 21 million Americans in 2015 suffered from Substance Use Disorder. Alcohol is the third leading cause of preventable death in the United States with nearly 88,000 people dying annually. Roughly 115 individuals within the United States die daily from an opioid overdose. Local Problem In 2017, Baltimore City, Maryland experienced 761 alcohol and drug related deaths. Patients with Substance Use Disorder continue to go undetected and do not receive appropriate care. The purpose of this project was to implement the SBIRT program as a quality improvement project to provide screening, a brief intervention, and referral to treatment for patients with Substance Use Disorder. Interventions This quality improvement project took place within a Baltimore City urgent care clinic that lacked an existing program screening for Substance Use Disorder. Team members included licensed practitioners, medical assistants, peer counselors, and front desk personnel. The project extended over a twelve-week period. Initial preparation required confirming staff roles, reviewing procedures, and identifying project champions. The subsequent period was spent disseminating project details as well as training staff members. All staff were trained by the project leader. The process of screening, brief intervention, and referral to treatment for Substance Use Disorder began in week five and continued through week twelve. The AUDIT-C questionnaire and a single substance use question were utilized as the screening tool. When a patient screened positive for Substance Use Disorder, the patient received a brief intervention by an SBIRT trained peer counselor. Patients received a referral for outside treatment depending upon the magnitude of substance use as well as the patient’s readiness for intervention. Results The implemented quality improvement project screened (n=556) patients or 38.6% of registered patients for Substance Use Disorder. Of those patients screened, (n=45) 8.1% screened positive for either alcohol or other substance misuse. Of the patients that screened positive (n=17) 37.8% received a brief intervention from a trained peer counselor or licensed provider. SBIRT screening as well as data collection and analyses processes were successfully implemented within the clinic’s electronic health record. Clinic administrators elected long-term adoption of the SBIRT program by making the SBIRT program a fixed function within the clinic. Conclusion This project indicated that nearly 10% of the population in Baltimore City continue to go unrecognize and untreated for Substance Use Disorder. Seventeen patients (37.8%) that screened positive for SUD received a brief intervention from a trained peer counselor or licensed provider and were provided with appropriate resources for treatment. The achievements of this quality improvement project demonstrate that the SBIRT program can be successfully implemented within an urgent care. The extension of similar programs is highly recommended to further reach out to this vulnerable population. Continuation of the program will allow an opportunity to refine processes, address the role of peer counselors, further train licensed providers to administer brief interventions, and work toward increasing the number of screenings, brief interventions, and referrals to treatment.