Implementing a team-based SBIRT model in primary care clinics

Background & aim: Six Oregon primary care clinics integrated a team-based, systematized alcohol and drug Screening, Brief Intervention, Referral to Treatment (SBIRT) process into their standard clinic workflow. Clinic staff administered screening forms and brief assessments, and clinicians were trained to perform brief interventions and treatment referrals when needed. Methods: Patient-level data from the electronic health record (EHR) were used to calculate implementation rates in each clinic specifically, how often each step of a 3-step SBIRT process was performed when indicated. Rates were tracked on a quarterly basis over 2 years. Results: Implementation rates increased over time for screening and assessment tasks performed by clinic staff, but not for brief interventions performed by clinicians. Averaged over time, annual screens were given to approximately 44% of eligible patients, brief assessments to around 66% of eligible patients, and brief interventions to about 40% of those eligible. Considerable variability existed across individual clinics, some of which demonstrated notably high rates. Conclusion: A team-based approach to SBIRT in primary care settings capitalizes on the medical home model but also creates unique challenges. Facilitative EHR tools are necessary.