Why is screening and brief Intervention for alcohol in healthcare not yet standard practice? The role of evaluation in understanding SBI adoption.
Melissa K. Richmond, PhD, Director of Research and Evaluation, OMNI Institute
Risky alcohol use is a serious public health concern. Each year, risky drinking negatively affects millions of lives, and billions of dollars are lost to impaired work productivity, injury, health issues, criminal justice involvement and motor vehicle accident. One approach to reduce the consequences of risky use is to universally and systematically screen individuals in healthcare settings about alcohol use. When patients indicate risky drinking, healthcare providers engage in a brief conversation aimed at motivating patients to reduce use. Years of research have demonstrated that screening and brief counseling for alcohol misuse in primary care is one of the most cost-effective preventive interventions available to healthcare providers.
Despite the strong evidence-base, screening and intervention for risky alcohol use is not standard practice in primary health care. It is estimated that three out of four risky drinkers pass through primary care settings without providers addressing their alcohol use. Implementation research suggests that this is not surprising: implementing new practices, even seemingly simple ones, often requires system, cultural and behavioral changes; relies on buy-in and active support from change agents; and takes time to make new practices into commonplace behaviors.
While relatively few in number, implementation studies on screening and brief intervention (SBI) adoption have identified several barriers to successfully incorporating SBI into primary and emergency care settings. These include healthcare professionals concerns about lack of time and competing priorities; feelings of inadequate preparedness to intervene when individuals screen positive, including some discomfort discussing substance use; difficulty in linking high-risk patients to more specialized treatment; and provider doubt in the effectiveness of the intervention or beliefs that substance risky use is outside physician/nurse scope of practice.
The findings suggest as Broyles and Gordon have concluded that the field needs more studies identifying successful screening and intervention approaches and models that can be realistically adopted in busy healthcare settings while demonstrating positive patient outcomes. Further, studies should explore methods of increasing healthcare providers’ acceptance of and engagement in alcohol screening and intervention. Evaluation studies, guided by implementation science,ii can help the field pinpoint feasible and effective SBI implementation strategies that will facilitate strong and widespread adoption.