A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs.

BACKGROUND: Many screening, brief intervention, and referral to treatment (SBIRT) training curricula have been implemented within graduate medical residency training programs, with varying degrees of success. The authors examined the implementation of a uniform, but adaptable, statewide SBIRT curriculum in 7 diverse residency training programs and whether it could improve resident knowledge, skills, and attitudes regarding SBIRT and unhealthy alcohol and other drug (AOD) use. METHODS: The authors assessed the implementation of the Pennsylvania SBIRT Medical and Residency Training (SMaRT) curriculum at 7 residency sites training a variety of disciplines. Faculty could use a variety of training modalities, including (1) Web-based self-directed modules; (2) didactic lectures; (3) small-group sessions; and/or (4) skill-transfer interactions with standardized or real patients in preceptor-led encounters. Acquisition of knowledge, skills, and attitudes regarding SBIRT and unhealthy AOD use-associated patient care were assessed via a pre- and post-survey instrument with 4 domains: Resident Knowledge, Resident Competence, Resident Skills and Attitudes (Alcohol), and Resident Skills and Attitudes (Drug). Responses to the pre- and post-surveys (N = 365) were compared and analyzed with t tests and Wilcoxon signed-rank tests. RESULTS: The diverse modalities allowed each of the residency programs to adapt and implement the SMaRT curriculum based on their needs and environments. Residents' knowledge, skills, and attitudes regarding SBIRT and working with unhealthy AOD use, as assessed by survey, generally improved after completing the SMaRT curriculum, despite the variety of models used. Specifically, Resident Knowledge and Resident Competence domains significantly improved (P < .000). Residents improved the least for survey items within the Resident Skills and Attitudes (Alcohol) domain. CONCLUSIONS: Adaptable curricula, such as SMaRT, may be a viable step towards developing a nationwide curriculum.

The pharmacist's role in overdose: Using mapping technologies to analyze naloxone and pharmacy distribution.

OBJECTIVES: To present preliminary research using geographic information system (GIS) mapping as a tool that can be integrated into pharmacy practice to increase access to and utilization of pharmacy-based interventions, including the distribution of naloxone. METHODS: Overdose death data was collected from medical examiner reports in an online database, and pharmacies carrying and distributing naloxone were determined by ZIP Code Tabulation Areas (ZCTAs) in Allegheny County, PA. The distribution of overdose death rates was analyzed in relation to naloxone-carrying pharmacies and all licensed pharmacies in the county with the use of GIS mapping. RESULTS: Eighty-seven ZCTAs were included. Of 322 active licensed pharmacies, 28 pharmacies were confirmed to carry and distribute naloxone. The number of overdose deaths in ZCTAs that have naloxone-distributing pharmacies was significantly higher than the average number of deaths in all ZCTAs in Allegheny County: 7.38 deaths versus 4.84 deaths, respectively (P = 0.021). CONCLUSION: This report illustrates the value of GIS mapping in monitoring the impact of overdose death prevention efforts, including the availability of naloxone in pharmacies. Analysis of these data over the next 5 years will provide valuable information on the potential impact of naloxone-distributing pharmacies on overdose rates, which, in turn, will inform pharmacists and pharmacy organizations on the value of carrying naloxone in pharmacies and inform local communities of its availability.

Incorporating screening, brief intervention, and referral to treatment into emergency nursing workflow using an existing computerized physician order entry/clinical decision support system.

INTRODUCTION: The objective of this study was to evaluate whether screening, brief intervention, and referral to treatment (SBIRT) could be incorporated into the emergency nursing workflow using a computerized physician order entry/clinical decision support system. We report demographic and operational factors associated with failure to initiate the protocol and revenue collection from SBIRT. METHODS: We conducted a retrospective, observational cohort analysis of a protocol adding SBIRT to the emergency nursing workflow of a single, tertiary care urban emergency department for all adult patient visits in 2012. Emergency nurses prescreened for unhealthy alcohol or drug use during triage assessment and, when positive, administered SBIRT during treatment area care, all documented in the computerized physician order entry/clinical decision support system. Using multivariable logistic regression, we report demographic and operational factors associated with failure to initiate the protocol. From October 2012, we submitted charges for brief interventions and analyzed collection results. RESULTS: The inclusion criteria were met for 47,693 visits. Of these, 39,758 (83.4%) received triage protocol initiation. Variables associated with decreased odds of protocol initiation were younger age (odds ratio [OR] for rising age, 1.044; 95% confidence interval [CI], 1.042-1.045), arrival by ambulance (OR, 0.37; 95% CI, 0.35-0.40), and higher triage acuity (OR, 0.08; 95% CI, 0.07-0.09). Of visits with protocol initiation, 21.4% were documented as positive for at-risk alcohol and/or drug use. However, brief interventions were only administered during 971 visits. During the billing period, $3617.53 was collected on charges of $10,829.15 for 262 completed brief interventions. DISCUSSION: In this study electronic documentation of adults with at-risk alcohol and/or drug use was feasible by emergency nurses, but SBIRT execution and subsequent revenue collection were challenging.