Alcohol Drinking as a Vital Sign
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/15/2019 |
| Start Date: | January 2010 |
| End Date: | December 2018 |
Alcohol SBIRT Implementation in an HMO: Non-Physician Providers Vs Physicians
The purpose of this study is to determine whether Alcohol Screening, Brief Intervention, and
Referral to Specialty Chemical Dependency Treatment (as appropriate) by Non-Physicians versus
Primary Care Providers (versus control group) is more likely to be implemented and more
effective at reducing unsafe drinking.
Referral to Specialty Chemical Dependency Treatment (as appropriate) by Non-Physicians versus
Primary Care Providers (versus control group) is more likely to be implemented and more
effective at reducing unsafe drinking.
This health services implementation study is a clustered, randomized trial. We propose to
randomize primary care clinics to three arms—a control condition and two alternative modes of
delivery of the NIAAA Clinician's Guide to Alcohol Screening, Brief Intervention, and
Referral to Treatment (SBIRT) in primary care settings. In the Primary Care Physician or
"PCP" arm, PCPs will be trained on the SBIRT protocols outlined in the NIAAA Clinicians'
Guide and conduct brief intervention and referrals as needed. In the Non-Physician Provider
or "NPP" arm, Medical Assistants will be trained to use the NIAAA screener and enter the
results in the Electronic Medical Record, and NPPs (e.g., Behavioral Medicine Specialists,
Clinical Nurses and Health Educators) will conduct brief intervention and referral
activities. The SBIRT content, based on the NIAAA Guide, is the same in both the NPP and PCP
arms; we compare delivery by the two types of providers and versus the control condition, in
which providers and staff will not receive any training on SBIRT protocols. We examine
implementation outcomes: rates of screening, brief intervention, follow-up screening and
brief intervention, referral to Chemical Dependency treatment, and alcohol use disorders
medication rates. We also include, as secondary analyses, an effectiveness study examining
patient outcomes by study arm.
randomize primary care clinics to three arms—a control condition and two alternative modes of
delivery of the NIAAA Clinician's Guide to Alcohol Screening, Brief Intervention, and
Referral to Treatment (SBIRT) in primary care settings. In the Primary Care Physician or
"PCP" arm, PCPs will be trained on the SBIRT protocols outlined in the NIAAA Clinicians'
Guide and conduct brief intervention and referrals as needed. In the Non-Physician Provider
or "NPP" arm, Medical Assistants will be trained to use the NIAAA screener and enter the
results in the Electronic Medical Record, and NPPs (e.g., Behavioral Medicine Specialists,
Clinical Nurses and Health Educators) will conduct brief intervention and referral
activities. The SBIRT content, based on the NIAAA Guide, is the same in both the NPP and PCP
arms; we compare delivery by the two types of providers and versus the control condition, in
which providers and staff will not receive any training on SBIRT protocols. We examine
implementation outcomes: rates of screening, brief intervention, follow-up screening and
brief intervention, referral to Chemical Dependency treatment, and alcohol use disorders
medication rates. We also include, as secondary analyses, an effectiveness study examining
patient outcomes by study arm.
Inclusion Criteria:
- Patients: All patients aged 18+ who receive primary care visits in the Kaiser
Permanente clinics in Northern California.
Exclusion Criteria:
- Patients younger than 18.
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