Download Addressing Substance Use as Part of Usual Care

Addressing Substance Use
as part of Usual Care
SBIRT - Screening, Brief Intervention, and Referral to Treatment
Alcohol + Cancer Forum
April 25, 2017
Staten Island University Hospital
Sandeep Kapoor, MD
Director, SBIRT
Northwell Health
Assistant Professor of Medicine
Hofstra Northwell School of Medicine
S
B
I
R
T
Northwell Health
Center for Addiction Services and Psychotherapy
Interventions Research (C A S P I R )
Division of General Internal Medicine
Department of Emergency Medicine
Department of Psychiatry & Behavioral Health
The National Center on Addiction
and Substance Abuse (CASA)
New York State Office of Alcoholism
and Substance Abuse Services (OASAS)
@ Northwell
Health
Substance Abuse and Mental Health
Services Administration (SAMHSA)
Northwell Sites for SBIRT Services
Westchester
Medical Center
Peconic
Bay
Lenox Health
Greenwich
Village
Emergency Department
Internal Medicine Practice
Future ED Sites (2017)
Inpatient Pilot
Educational Efforts
To identify and
effectively intervene
with those who are at
moderate or high risk for
psychosocial or health
care problems related to
their substance use
Nurses
Physicians
Medical
Assistants
PAs
Patient
Health
Coaches
Pharmacists
SUD
Providers
SWs
The SBIRT Process
‘Starting the conversation…’
SBIRT
Screening
Components
Valid evidence -based questionnaire administered with
patient
< 3 minutes
Discussion with health care professional focused on
reducing or stopping unhealthy substance use:
Brief Intervention
1. Assessment & feedback on substance use
2. Simple advice, goal setting, agree on plan
5-20 minutes
Referral to Specialty
Treatment
Based on extent of substance use/abuse, patients may
require more than a brief intervention
Every effort is made, in real-time, to provide a ‘warm
handoff’ to community treatment providers and those
within the Northwell Health
The Brief Negotiated Interview
A semi-structured interview process based on Motivational Interviewing
that is a proven evidence-based practice and can be completed in 5−20
minutes
Steps in the BNI
1.
2.
3.
4.
Raise the Subject
Provide Feedback
Enhance Motivation
Negotiate and Advise
Special acknowledgement is made to Drs. Stephen Rollnick, Gail D’Onofrio, and Ed Bernstein for granting
permission to orient participants to the “brief negotiated interview.”
n= 217
n= 147
The Issue
2-3
______ dedicated to educational training
on substance use/addictions during residency
Compared to 1 in 25 Americans who first drank,
Azari S, et al. MedEdPORTAL
smoked or used other drugs at age 21 or older
Publications. 2015
Major source of referrals to treatment
are NOT healthcare providers
only 6.6%
SAMHSA (2011). 2010 National Survey on Drug Use and Health
Motivate a Shift in our Clinical Culture
Substance Use/Misuse
is truly a Healthcare
Core
Issue
Mission
Enhancing Awareness,
Skills, and Comfort
Key Elements to Consider
Normalizing the Conversation
Rethinking our Approach
Curriculum Development
Normalizing the Conversation
• Screen at every visit, every time
• Thoughtful training
• Align w/ vital signs
• Use signage
• Involve WHOLE Team
Key Elements to Consider
Normalizing the Conversation
Rethinking our Approach
Curriculum Development
Making the Connection
*DID YOU KNOW?
SBIRT has allowed us to NORMALIZE the discussion
and treat substance use as the healthcare issue it is
The Million Women Study in the UK:
to preventative
screenings
for chronic diseases
•Similar
approx. 28,000
women w/ breast
cancer
(ie. diabetes and hypertension)
• estimated every 10g of alcohol (<
•
1 glass of wine) consumed/day
was associated with 12% increase in the risk of breast cancer
Risky use
Heart Disease
Allen NE, et al. - Journal
of the National Cancer Institute 2009;101(5):296-305
Hypertension
Gastritis
Sleep
Depression
STDs
Fetal alcohol spectrum disorders
Cancers*
Yes…
Type 2Use
Diabetes
Substance
Continuum
Overweight
Obese
Prediabetes
Type II DM
High Risk
Rethinking Substance Use Problems
From a Public Health Perspective
Key Elements to Consider
Normalizing the Conversation
Rethinking our Approach
Curriculum Development
Empowering the Current Generation
of Clinical Team Members
Workforce Training and Development – Get your folks trained!
FREE!
• 4.0 CME/CEU/CE Credits
• NYS OASAS Certification – SBIRT Provider
Empowering the Next Generation
of Clinical Team Members
Hofstra Northwell School of Medicine
2013 - 2014
MS1
2 hours
2014 - 2015
2015 - 2016
2016-2017
MS1 & MS2
MS1 & MS2
MS1 – MS4
4+ hours
8+ hours
12+ hours
+ examinations
+ examinations
+ 2wk IPE Elective
Our curriculum is collaboratively taught by an
interprofessional interdisciplinary team:
• SOM Communications Faculty
• SBIRT Clinical Faculty (IM/EM/Psychiatry)
• SBIRT Health Coaches
Evaluating our
Curricula Efforts
2015 - 2016
MS1 & MS2
8+ hours
+ examinations
Knowledge:
98% of MS1s and 100% of MS2s received passing scores on exam question
Skills:
Full credit (given by SPs) in the following categories:
• being non-judgmental (99%)
• screening (93%)
• patient education (93%)
• 71% of MS2s provided feedback on SP alcohol use, a second-year skill
Attitudes:
Following sessions, students reported:
• being more confident asking patients about substance use (3.6 vs 2.8, p<0.001)
• being more confident with assessing patient readiness to change (3.7 vs 2.9, p<0.001)
Thank You
For more information
[email protected]
[email protected]