Technology Guided SBIRT
by Kevin Glibert,Ph.D. with HeartSmartKids
We have all heard the refrain that anything can be improved with technology. As any veteran of current medical computing knows, this point of view can be frustrating and often wrong. But a recent partnership between SBIRT Colorado and HeartSmartKids is showing technology’s potential when used in an appropriate way to improve primary care screening and brief counseling to address alcohol and drug use.
HeartSmartKids has worked for nearly a decade to impact the epidemic of childhood obesity. Our approach is to use technology to improve the conversations on health behaviors that occur in primary care. There is a very limited amount of time available in normal medical visits, so the discussion must be focused on what is relevant to the patient and what is most likely to benefit their health. A practitioner needs to know not just about their patient’s habits, but also their desires, knowledge, community resources, and more. HeartSmartKids gathers a lot of that information together and presents it in such a way that discussions are positive, effective, and brief. Research in metro Denver has shown that these brief discussions can lead to better habits and healthier growth across a whole population of kids.
In 2015 HeartSmartKids and SBIRT Colorado teamed up to bring these same ideas to primary care screening for adult alcohol use and teen substance use. Building on the SBIRT process and using screening instruments like the AUDIT and CRAFFT, we created an iPad-based screening system and patient reports that can facilitate the conversation. The report includes substance use risk level and initial assessment of patient readiness and confidence to change.
Using technology to do this screening has advantages:
- Improvement in screening efficiency and scoring accuracy.
- Assistants save time in administering the screening.
- Practitioners save time because the discussion guidance directs them quickly to the most important and relevant topics.
- Since the screenings are done electronically, the data is stored either as part of a patient record or anonymously—and can be accessed later to study patterns, look at statistics, or address quality measures and reimbursement.
- One of the keys to effective interventions is directing patients to the community or clinic resources that match them best. Technology can bring community and referral information, tailored for a specific patient, right to the practitioner for discussion.
Other aspects of screening with technology seem promising but the effects are unknown. How will people react to answering substance use screening questions on a tablet? Will they be more or less honest, since the tablet can be less judgmental? What is the best way to gather information on local referrals and community resources? How can we “close the loop” and find out if patients accessed referrals? We look forward to investigating these questions.
The SBIRT tools are being tested in 2016 and feedback is being gathered from pilot test clinics. One of the initial responses from a practitioner is that she is having many more brief, positive, and preventive conversations with moderate risk patients, rather than waiting until they become high risk. This kind of result is very consistent with the preventive population health focus of SBIRT Colorado and HeartSmartKids.