Focus on Research May 2013

Focus on Research:

Grant Aids in Teaching SBIRT to Primary Care Residents

Jim Winkle, MPH
Jim Winkle, MPH
 John Muench, MD
John Muench, MD

By Jim Winkle, MPH; John Muench, MD

SBIRT stands for screening, brief intervention, and referral to treatment- an evidence-based, effective method to intervene in unhealthy alcohol and drug use, but that is currently under-used in the primary care setting in the United States.  

Our project, the SBIRT Oregon Primary Care Residency Initiative, is one of 18 residency curriculum projects supported by SAMHSA to teach the SBIRT method to primary care residents. We received this grant in 2008, and with six months left, we’re on track to train almost 400 internal, preventive, and family medicine residents throughout Oregon. As these physicians graduate from residency and enter their own medical practices, we can expect they will be more confident and better equipped to help patients with substance use problems and will make a meaningful difference in the health of our Oregon communities. 

Although our project was tasked with training residents specifically, we believed clinicians of the future would practice in the team-based environment of the “patient-centered medical home.” Consequently, our project taught a specific office process in which annual screening is conducted by clinic staff using paper or electronic medical record screening tools. We then taught resident physicians (and to a lesser extent, faculty) to perform patient-centered brief interventions through video examples and role play. Having completed a three-hour curriculum, residents returned to their clinics with office screening systems in place, ready to immediately take part in a process that can usually be carried out within the context of a 15-minute primary care visit. This clinic workflow was implemented in seven clinics: OHSU Richmond, OHSU South Waterfront, OHSU Gabriel Park, OHSU Internal Medicine, Providence Milwaukie, Providence SE Portland, and Cascades East. 

Our project helped facilitate this workflow by creating new tools in four different electronic medical records systems (EMR) used by participating clinics. These tools, such as the SmartSet, SmartPhrase, and DocFlow sheet, automate the note taking portion of the visit, allow for screening results to be recorded, and make it easier for providers to bill accordingly. These tools will remain after the project expires and can be easily duplicated or used immediately by clinics who use OCHN EPIC.

More measurable achievements of our project include: 

  • Demonstrated and sustained improvements in resident attitudes, knowledge and behavior towards SBIRT
  • Clinic implementation rates of screening and brief intervention that would likely exceed SBIRT improvement targets expected to be set by the Oregon Health Authority
  • 4-5 manuscripts to be submitted for publication

Perhaps another legacy our project leaves behind is a website that acts as a one-stop resource for clinics wanting to download clinic tools and screening forms, watch training videos, or engage in an interactive online curriculum ( Google “SBIRT” and our project usually appears in the top 5 or 6 results. 

Looking towards the future, two major changes in the health care environment in Oregon have created a unique opportunity to widely implement and sustain SBIRT processes in primary care settings throughout the state:

  • The restructuring of healthcare financing through Coordinated Care Organizations (CCOs)
  • The presence of a shared electronic health record platform (OCHIN EPIC) that covers an ever greater proportion of uninsured and government insured patients in the state.

As our team applies for new funding, we look to coordinate SBIRT implementation with the development of Oregon’s CCOs to enhance the impacts and benefits from routine population-based screening, brief intervention and referral to treatment.