Evaluation of the Washington state screening, brief intervention, and referral to treatment project: cost outcomes for Medicaid patients screened in hospital emergency departments.
ABSTRACT Substance abuse is a major determinant of morbidity, mortality, and health care resource consumption. We evaluated a screening, brief intervention, and referral to treatment (SBIRT) program, implemented in 9 hospital emergency departments (ED) in Washington State.
Working-age, disabled Medicaid patients who were screened and received a brief intervention (BI) from April 12, 2004 through September 30, 2006 were included in the study's intervention group (N = 1557). The comparison group (N = 1557), constructed using (one-to-one) propensity score matching, consisted of Medicaid patients who received care in one of the counties in which an intervention hospital ED was located but who did not receive a BI. We estimated difference-in-difference (DiD) regression models to assess the effects of the SBIRT program for different patient groups.
The SBIRT program was associated with an estimated reduction in Medicaid costs per member per month of $366 (P = 0.05) for all patients, including patients who received a referral for chemical dependency (CD) treatment. For patients who received a BI only and had no CD treatment in the year before or the year after the ED visit, the estimated reduction in Medicaid per member per month costs was $542 (P = 0.06). The SBIRT program was also associated with decreased inpatient utilization (P = 0.04).
SBIRT programs have potential to limit resource consumption among working-age, disabled Medicaid patients. The hospital ED seems especially well suited for SBIRT programs given the large number of injured patients treated in the ED and the fact that many conditions treated are related to substance abuse.
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- "Over the past 20 years, many research studies have focused on the value of SBIRT as a harm reduction model for at-risk alcohol use with significant impacts on patient safety and health care costs (InSight Project Research Group 2009; Madras et al. 2009; Saitz 2008; Babor et al. 2007; Bien, Miller & Tonigan 1993). SBIRT has been clearly described and is teachable; however, it is not widely implemented (Estee et al. 2009; Bernstein et al. 2007). "
ABSTRACT: Prescription drug abuse is increasing at alarming rates in this country. Most often drugs are obtained through relatives or friends. An important step in addressing this problem is educating healthcare providers in the proper prescribing of scheduled drugs. Physicians and other healthcare workers receive little training in proper screening for substance abuse, proper prescribing of scheduled drugs, and referral for those needing treatment. Continuing medical education is one venue for addressing this problem. However, screening, brief intervention and referral for treatment (SBIRT) should be taught in medical school and residency.Journal of psychoactive drugs 01/2012; 44(1):79-85. DOI:10.1080/02791072.2012.662081 · 1.10 Impact Factor
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- "In a quasiexperimental multi-site study of SBIRT in Emergency Departments, researchers found that brief intervention was effective in reducing alcohol consumption at 3 month follow-up (Academic ED SBIRT Research Collaborative, 2007). In the Emergency Department SBIRT program in Washington State, researchers found that those who received SBIRT services were more likely to access substance abuse treatment (Krupski et al., 2010) and incurred fewer Medicaid costs (Estee et al., 2010) than matched comparison groups. Another study found substantial decreases in drug use and heavy drinking among individuals receiving SBIRT in a public healthcare system where SBIRT was implemented as standard care (InSight Project Research Group, 2009). "
ABSTRACT: Recent years have seen increased diffusion of Screening, Brief Intervention, Referral and Treatment (SBIRT) in healthcare environments. This study examined the relationship between substance use outcomes and service variables within the SBIRT model. Over 55,000 adult patients were screened for substance misuse at rural health clinics throughout New Mexico during the SBIRT Initiative. This naturalistic pre-post services study used administrative baseline, 6 month follow-up, and services data for adult participants in the New Mexico SBIRT evaluation (n=1208). Changes in self-reported frequency of illicit drug use, alcohol use, and alcohol intoxication were examined as a function of service level (brief intervention - BI vs. brief treatment/referral - BT/RT) and number of service sessions. Participants reported decreased frequency of illicit drug use, alcohol use, and alcohol intoxication 6 months after receipt of SBIRT services (p<.001 for each). Compared to those who received BI, participants who received BT/RT had sharper reductions in frequency of drinking (IRR=.78; p<.05) and alcohol intoxication (IRR=.75; p<.05). Number of service sessions was associated with reduced frequency of alcohol use (IRR=.84; p<.01) and intoxication (IRR=.82; p<.05), but only among those who received BI. Substance-using patients with disparate levels of use may benefit from SBIRT. In a real-world, multi-site rural SBIRT program, services of higher intensity and (within the BI modality) frequency were associated with greater magnitude of change in drinking behaviors. Reductions in illicit drug use, while substantial, did not differ significantly based on service variables. Future studies should identify the preferred service mix in the SBIRT model as it continues to expand.Drug and alcohol dependence 04/2011; 118(2-3):152-7. DOI:10.1016/j.drugalcdep.2011.03.012 · 3.28 Impact Factor
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ABSTRACT: Integrating substance use disorder (SUD) services with primary care (PC) can improve access to SUD services for the 20.9 million Americans who need SUD treatment but do not receive it, and help prevent the onset of SUDs among the 68 million Americans who use psychoactive substances in a risky manner. We lay out the reasons for integrating SUD and PC services and then explore the models used and the experiences of providers as they have begun SUD/PC integration in California.Journal of psychoactive drugs 09/2012; 44(4):299-306. DOI:10.1080/02791072.2012.718643 · 1.10 Impact Factor