SBIRT in primary care
The integration of SBIRT into primary care
Carolyn Swenson, MSPH, MSN, FNP, Senior Project Manager, HealthTeamWorks
A primary care patient-centered medical home is the ideal place to address all aspects of health and wellness including alcohol. However, a recent report issued in January 2014 from the CDC found that very few healthcare professionals talk with their patients about alcohol.This despite the fact that the United States Preventive Services Task Force recommends that clinicians routinely screen patients for alcohol misuse and provide a brief intervention to promote adherence to moderate drinking levels. Why isn’t alcohol screening and brief intervention happening more often in primary care? Especially since drinking alcohol above moderate levels contributes to a wide range of health problems including cardiovascular disease, cancer, gastrointestinal diseases, unintended pregnancy, sexually transmitted infections, injury, domestic violence, depression and suicide. Some clinicians believe that they will recognize which patients are drinking too much alcohol without using a validated screening question. However, only four to five percent of adults in the U.S. have alcohol dependence, while approximately 25 percent drink above moderate levels and may not present with any obvious signs of problematic drinking. Sometimes this is the issue. The good news is that alcohol screening and brief intervention really is brief (five-10 minutes) in most cases. And when there is insufficient time to address alcohol, the issue can be addressed effectively at a follow-up visit. Also, different members of the healthcare team can be trained to help to carry out alcohol screening and brief intervention including medical assistants, nurses, health educators, behavioral health professionals and primary care clinicians. Some practices are concerned about getting reimbursed for the service. Fortunately alcohol screening and brief intervention is a reimbursable service and one of the covered prevention services under the Affordable Care Act. Most important to note is that this is an evidence-based practice that really does work to decrease the burden of disease and the enormous healthcare and other costs to society that are caused by excessive alcohol intake! So, let’s look forward to the day when every patient-centered medical home routinely talks with their patients about alcohol use.