Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings

Rahm, Alanna Kulchak; Boggs, Jennifer M.; Martin, Carmen; Price, David W.; Beck, Arne; Backer, Thomas E.; Dearing, James W.

doi:10.1080/08897077.2014.951140

Cited by 150Substance Abuse Treatment and OutcomesHealth Policy Implementation ScienceOpioid Use Disorder Treatment

Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings

Rahm, Alanna Kulchak, Boggs, Jennifer M., Martin, Carmen, Price, David W., Beck, Arne, Backer, Thomas E., Dearing, James W.·2015·Substance Abuse

DOI 10.1080/08897077.2014.951140

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Abstract

BACKGROUND: Substance abuse in the United States is a serious public health concern impacting morbidity and mortality. However, systematic screening and intervention has not been widely adopted into routine practice by health care organizations and routine screening and intervention is not currently in place for primary care at Kaiser Permanente Colorado. Therefore, a formative evaluation was conducted to explore and enhance implementation of the Substance Abuse and Mental Health Services Administration (SAMHSA) screening, brief intervention, and referral to treatment (SBIRT) approach in the organization. METHODS: Key clinical stakeholders, including internal and family medicine physicians, primary care nurses, mental health therapists, chemical dependency clinicians, and clinic-based psychologists provided feedback. Two focus groups were also conducted with patient stakeholders: one in English and one in Spanish. RESULTS: All clinical stakeholders promoted clinic-based psychologists to conduct brief intervention and determine referral to treatment as the optimal implementation program. Inclusion of the patient perspective also highlighted the importance of considering this perspective in implementation. Both patient groups were generally supportive of SBIRT, especially the educational value of screening questions defining healthy drinking limits; however, English-speaking patients noted privacy concerns and Spanish-speaking patients noted frequently being asked about drug or alcohol use. Organizationally, systems exist to facilitate drug and alcohol use screening, intervention, and referral to treatment. However, physician time, alignment with other priorities, and lack of consistent communication were noted potential barriers to SBIRT implementation. CONCLUSIONS: Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening, but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.

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Depression is associated with worse clinical outcomes and higher mortality in chronic liver disease.
“Depression remains under diagnosed and untreated in CLD10 and is associated with worse clinical outcomes and higher mortality.11”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [11]

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PS1-18: Feasibility of Implementing Screening Brief Intervention and Referral to Treatment (SBIRT) Within Multiple Health Settings
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Perceptions of Clinical Team Members Toward Implementation of SBIRT Processes
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PS1-20: Integrating Alcohol and Drug Use Screening for Adolescents into Mental Health Settings: Rationale, Missed Opportunities and Outcomes
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Authors: Rahm, A. K., Boggs, J. M., Martin, C., Price, D. W., Beck, A., Backer, T. E., & Dearing, J. W.
Affiliations: Kaiser Permanente (US)
Human Interaction Research Institute, Encino, California, USA
Corresponding author: Rahm, Alanna Kulchak
ORCID: Rahm, Alanna Kulchak
Boggs, Jennifer M.
Price, David W.
Beck, Arne
Dearing, James W.
Venue: Substance Abuse
Publisher: SAGE Publications
Published: 2015-07
Volume: 36
Issue: 3
Pages: 281-288
ISSN: 0889-7077 (ISSN-L)
1547-0164
DOI: 10.1080/08897077.2014.951140
OpenAlex: W1609891162
Cited by: 150
References: 36
Citations by year: 2026: 1 · 2025: 9 · 2024: 16 · 2023: 13 · 2022: 9 · 2021: 22 · 2020: 11 · 2019: 25 · 2018: 13 · 2017: 16 · 2016: 5 · 2015: 9
FWCI: 7.55
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Substance Abuse (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: SBIRT, substance use screening, alcohol screening, implementation barriers and facilitators, primary care, integrated care, referral to treatment, patient perspectives, cultural differences, Spanish-speaking patients, physician time constraints, organizational leadership, Kaiser Permanente
MeSH terms: Attitude of Health Personnel, Colorado, Health Services Accessibility, Humans, Mass Screening, Patient Participation, Primary Health Care, Psychotherapy, Brief, Referral and Consultation, Substance-Related Disorders

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Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings

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