SBIRT: Screening

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-	==RLSP SBIRT:'''[[Screening]]''' for Substance Abuse==	+	=='''RLSP''' SBIRT: '''[[Screening]]''' for Substance Abuse==

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Revision as of 15:17, 20 November 2009

Contents 1 RLSP SBIRT: Screening for Substance Abuse 1.1 Goal 1.2 Instructional Format 1.3 Skills Development and Learning Objectives 1.4 Standardized Patient Interviewees 1.4.1 40 year old white female 1.4.2 54 year old white Hispanic male 1.4.3 66 year old African American male 1.4.4 30 year old white female

RLSP SBIRT: Screening for Substance Abuse

Goal

The physician/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.

Instructional Format

Review appropriate background/resource supports that are provided including step-by-step guides; interview 1 to 4 SPs via online chat; complete guided self-assessment; review tailored feedback based on that assessment, and receive CME credit based on number of cases completed.

Skills Development and Learning Objectives

The physician/learner will be able to:

1. Select appropriate screening tools for substance use problems
   1. Select questionnaires to screen for substance use problems (based on time available for screening, whether a written or oral interview is desired, etc.)
   2. Test for drugs in bodily fluids and other laboratory tests when appropriate
2. Screen effectively for substance use problems in an initial patient interview, as part of a scheduled update, or when discussing results from written questionnaires
   1. Use motivational interviewing techniques (e.g., being sensitive to the patient's perspective, listening effectively, conveying a non-judgmental attitude, use of empathy)
   2. Convey the importance of the issue with respect to patient and family members
3. Interpret substance abuse screening results
   1. Interpret results of screening tool according to scoring guidelines
   2. Combine screening tool results with other clinical information
   3. Determine the extent of the problem
4. Triage patients to the appropriate level of care within your practice
   1. Use screening result to triage patient from no intervention to brief intervention by primary care only or brief intervention by primary care plus referral.
   2. Schedule additional time for brief intervention if needed

Standardized Patient Interviewees

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