SBIRT: Screening

From Clinicaltools.com

Contents 1 Course Title: Screening for Unhealthy Alcohol Use or Drug Abuse 2 Course Need/Practice Gaps 3 Course Goal 4 Core Competencies & Clinical Skills 5 Corresponding JCAHO Guideline 6 Other Related Clinical Guidelines 7 Case Studies and Remote Live Standardized Patients 7.1 40 year old white female 7.2 54 year old white Hispanic male 7.3 66 year old African American male 7.4 30 year old white female

Course Title: Screening for Unhealthy Alcohol Use or Drug Abuse

Course Need/Practice Gaps

It is estimated that approximately 20% of all patients who see a primary care physician (PCP) have a substance use or abuse problem (Mersy, 2003; Madras et al., 2009). Unfortunately, few PCPs are routinely providing substance use screening or intervention with their patients (Roche and Freeman, 2004; D'Amico et al., 2005).

Course Goal

The learner will be able to appropriately screen for and identify substance abuse and triage patients with substance use problems to their appropriate level of care.

Core Competencies & Clinical Skills

Each learner should be more proficient in the following core competencies and clinical skills after completing this course:

Selecting appropriate screening tools for substance abuse problems based on patient history and characteristics

1. Selecting questionnaires to screen for substance use problems (based on time available for screening, whether a written or oral interview is desired, etc.)
2. Testing for drugs in bodily fluids and other laboratory tests when appropriate

Screening patients effectively for substance use problems

1. Using motivational interviewing techniques (e.g., being sensitive to the patient's perspective, listening effectively, conveying a non-judgmental attitude, use of empathy)
2. Determining the extent of the problem

Interpreting substance abuse screening results

1. Interpreting results of screening tool according to scoring guidelines
2. Combining screening tool results with other clinical information

Triaging patients to the appropriate level of care within your practice

1. Using screening result to triage patient from no intervention to brief intervention by primary care only or brief intervention by primary care plus referral
2. Scheduling additional time for brief intervention if needed

Corresponding JCAHO Guideline

Guideline Name: Alcohol and Other Drug Use Screening

Measure of Success: Increase in the number of hospitalized inpatients, 12 years of age and older who are screened for alcohol and drug use, using validated screening tools for unhealthy drinking and drug use.

Other Related Clinical Guidelines

• Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (U.S. Preventive Services Task Force, 2004)

Case Studies and Remote Live Standardized Patients

40 year old white female

• Chief Complaint: General checkup due to fatigue and anxiety
• Narrative: Cynthia was motivated to get this physical exam due to fatigue and anxiety, which have slowly built up over the past three months. She also is feeling mildly depressed due to financial worries after totaling her car recently, problems at work, and a five pound weight gain.
• Substance Use Problem: Severe alcohol use problem.
• Relevant Past Medical, Psychosocial, Family History: Motor vehicle accident three months ago. Father has a history of coronary heart disease.
• Objective(s) Covered: 1-1, 2, 3, 4

54 year old white Hispanic male

• Chief Complaint: Upper respiratory infection with cough and fever
• Narrative: Alberto developed a cold three days ago that progressed into a productive cough. He would like medications so he can get back to work quickly as he does not get paid when sick.
• Substance Use Problem: Smokes two packs of cigarettes per day.
• Relevant Past Medical, Psychosocial, Family History: Frequent past visits for colds
• Objective(s) Covered: 1-1, 2, 3, 4

66 year old African American male

• Chief Complaint: Requests pain medication refill.
• Narrative: Benjamin is a chronic pain patient with a prescription opioid misuse problem. He is returning to a private practice primary care physician, as that physician directed, for a re-evaluation in order to get a refill on his prescription pain medication for chronic back pain.
• Substance Use Problem: Takes more prescription pain medication than directed; takes them sporadically; supplements the prescribed medication with previously prescribed medication obtained from another doctor.
• Relevant Past Medical, Psychosocial, Family History: Benjamin has chronic back pain secondary to trauma from a fall 20 years ago.
• Objective(s) Covered: All

30 year old white female

• Chief Complaint: Would like sedative medication for increasing irritability and restlessness.
• Narrative: Stephanie uses cocaine on weekends socially, but in the past few months has increased to more frequent use by herself.
• Substance Use Problem: Uses cocaine.
• Relevant Past Medical, Psychosocial, Family History: Emergency department visit one month ago for nose bleed. She is in psychotherapy for a mental health problem (personality disorder).
• Objective(s) Covered: All