Impacts of an Urban Screening, Brief Intervention, and Referral to Treatment Program

Transcription

1 Impacts of an Urban Screening, Brief Intervention, and Referral to Treatment Program Kerry B. Broderick, BSN,MD Denver Health Medical Center Associate Professor of Emergency Medicine Team SBIRT Colorado at Denver Health made possible by a generous grant from CSAT/SAMHSA

2 Denver Health Medical Center Level One Trauma Center Quasi-County facility Downtown Denver > 400 in-patient beds 7 Community clinics

3 Background Through December 2010, SBIRT Colorado provided SBIRT services to over 100,000 people statewide Between April 2007 and December 2010: DHMC hospital staff and health educators have provided SBIRT services to over 50,000 patients

4 Patients are first screened with the Brief Screen tool by non-grant-funded clinical staff Either at intake via the Medical Screening Exam (MSE) or at bedside Background

5 MSE Brief screen

6 Accessing SBIRT info on EMeSIS Pending/Plan/Notes In the New Orders

7 The Great Paper Chase

8 Process Following the DH clinician-administered Brief Screen: Program health educators administered the Alcohol, Smoking, and Substance Involvement Screening Tool (ASSIST) Baseline data were collected using Government Performance Results Act (GPRA) instruments

9 The BI Health Educators provided brief intervention to the majority of patients who screened positive Concentrating on At-Risk patients Cautions and balances

10 The RT Referral to Treatment Grant funding provided for up to 8 weeks of out-patient treatment

11 Evaluation Approximately 10% of positives were eligible for enrollment for follow-up at 6 months Incentives were used for enrollment: $10 gift card at enrollment $20 gift card mailed to patient upon completion of follow-up survey

12 Evaluation Follow-up conducted by OMNI Institute in Denver, Colorado OMNI Institute conducts the outcomes evaluations for all SBIRT Colorado sites

13 Screens Per Month Number of Screens Apr- 07 Jul- 07 Oct- 07 Jan- 08 Apr- 08 Jul- 08 Oct- 08 Jan- 09 Apr- 09 Jul- 09 Oct- 09 Jan- 10 Apr- 10 Jul- 10 Month April 2007-July 2010

14 Demographics Intake data April 2007-Dec Gender Frequency Percent Male 23, % Female 26, % Total 50,010

15 Demographics Age Frequency Percent , % , % , % , % , % > 65 3, %

16 Demographics Race/Ethnicity Frequency Percent White 20, % Black 8, % Hispanic 18, % Asian %

17 Percent at Risk by Substance by Age Group Alcohol Percent 20% 15% 10% 5% 0% Cannabis Cocaine Amphetamine Opioids Sedatives 18 to to to to to and older April 2007-July 2010

18 Percent at Risk by Substance by Gender 16% Male Percent 14% 12% 10% 8% 6% 4% 2% Alcohol Cannabis Cocaine Amphetamine Opioids Female Sedatives 0% April 2007-July 2010

19 Percent Screening at Risk by Substance 12% Percent 10% 8% 6% 4% 2% Alcohol Cannabis Cocaine Amphetamines Opioids Sedatives 0%

20 Services needed Low or No 50% Tobacco only 29% High 3% High Moderate 3% Moderate 15%

21 6- month Impact Average Number of Days of Use in the Past 30 Days at Intake and at Follow -up Number of Days Intake Follow -up 0 Alcohol (N=190) Illegal Drugs (N=274) April 2007-July 2010

22 6- month Impact Average Number of Days of Use in the Past 30 Days at Intake and at Follow -up Intake Number of Days Follow -up 0 Cannabis (N=219) Cocaine (N=62) April 2007-July 2010

23 Current efforts Updated module for nursing orientation Built it into the annual nursing core competency s Updated training module hospital wide NEO Trying to re-brand ourselves Healthy Living

24 Current Challenges Sustainability Executive Summary March 2011 Seek Foundation matching funds Billing and reimbursement Transition of data

25 Current Challenges Standard of Care Work with health providers AND Insurances Medicine, Nursing, Dental, Medical Schools, Residencies, The Joint Commission, etc

26 Questions? Thanks to my CO SBIRT Team! & Peer Assistance SAMHSA ADAD CSAT