Article Figures & Data
Figures
- Figure 1.
Consort diagram.
Tables
Session/Topic Virtual Practice Facilitation Virtual Practice Facilitation + eLearning 1: Introduction/ Complete baseline surveys Complete two surveys; review baseline SBIRT patient metrics; identify practice champions; prepare for Session 2. Complete two surveys; review baseline SBIRT patient metrics; identify practice champions; prepare for Session 2. 2: SBIRT Introduction, Screening for UAU and AUD Review SBIRT
Using Screening eLearning module: Review practice’s current process for screening for UAU/AUD
Review SBIRT
Set goals for screening
Review practice’s current process for screening for UAU/AUD
Complete screening PDSA cycle within module
3: Brief Intervention Review goals from UAU/AUD screening
Using Brief Intervention eLearning module: Discuss brief intervention
Review screening PDSA cycle and determine changes
Set goals for brief intervention
Discuss brief intervention
Complete brief intervention PDSA cycle within module
4: Medication Assisted Therapy (MAT) Review goals from brief intervention
Using MAT eLearning module: Discuss MAT
Review brief intervention PDSA cycle and determine changes
Set goals for MAT
Discuss MAT
Complete MAT PDSA cycle within module
5: Team-Based Care for SBIRT/MAT Review goals from MAT
Using Team-Based Care eLearning module: Discuss team-based SBIRT/MAT care
Review MAT PDSA cycle and determine changes
Set goals for team-based SBIRT/MAT
Discuss team-based SBIRT/MAT care
Complete team-based care PDSA cycle within module
6: SBIRT/MAT Sustainability Plan Review goals from team-based SBIRT care
Using SBIRT/MAT Sustainability eLearning module: Discuss SBIRT/MAT sustainability plan
Review team-based care for SBIRT/MAT PDSA cycle and determine changes
Set goals for SBIRT/MAT sustainability plan
Discuss SBIRT/MAT sustainability plan
Complete SBIRT/MAT sustainability plan PDSA cycle within module
7: 9-month Final Data Collection Complete SBI/RT + MAT Checklist Survey
Complete SBI/RT + MAT Checklist Survey
Complete patient SBI/RT + MAT metrics
Complete patient SBI/RT + MAT metrics
Abbreviations: SBIRT, Screening Brief Intervention and Referral to Treatment; UAU, Urinalysis and Urine Culture; AUD, Alcohol Use Disorder; PDSA, Plan-Do-Study-Act; RT, Respiratory Therapy.
Survey Name Variables Collected Source of Data Timing of Completion SBI/RT + MAT checklist 13-item survey to determine SBI/RT + MAT implementation Survey completed by PF and key practice members Baseline and 9-months Practice characteristics survey 20-item survey to determine key practice characteristics Survey completed by practice manager or medical director Baseline Unhealthy alcohol use SBI/RT + MAT patient measures # of unique patients screened for UAU over past 3 months EHR or patient registry Baseline, 3, 6, 9 months (look back from prior 3 months) # of unique patients screened + for AUD over past 3 months # of unique patients receiving brief intervention for UAU over past 3 months # of unique patients receiving MAT for AUD over past 3 months # of unique patients referred to specialty clinic for treatment of AUD over past 3 months Abbreviations: SBI/RT + MAT, screening, brief intervention, referral, treatment plus medication assisted treatment; PF, practice facilitator; UAU, unhealth alcohol use; AUD, alcohol use disorder.
Standard PF PF with eLearning Total n = 24 n = 27 n = 51 Practice Characteristics n (%) or Mean (SD) n (%) or Mean (SD) n (%) or Mean (SD) P-value Specialty 0.5507 Family medicine 16 (67%) 15 (56%) 31 (61%) Internal medicine 4 (17%) 8 (30%) 12 (24%) Other* 4 (17%) 4 (15%) 8 (16%) Number primary care clinicians 4.8 (2.6) 6.8 (9.1) 5.8 (6.7) 0.3215 Number psychiatrists 0.09 (0.42) 0.09 (0.43) 0.09 (0.42) 0.5902 Number pharmacists 0 (0) 0.07 (0.23) 0.04 (0.17) 0.2001 Number nursing staff 5.0 (3.7) 5.9 (5.4) 5.5 (4.6) 0.5140 Number behavioral health 1.6 (1.8) 1.3 (1.8) 1.5 (1.8) 0.6281 Practice ownership 0.9243 Clinician owned 12 (50%) 12 (44%) 24 (47%) Safety net or similar 4 (17%) 5 (19%) 9 (18%) Hospital/system owned 8 (33%) 10 (37%) 18 (35%) Number of patient visits per week 225.4 (156.9) 171.3 (162.2) 197.8 (160.3) 0.2420 Payor mix* % Private 46.8 (27.2) 41.9 (25.1) 44.1 (16.0) 0.5109 % No insurance/self-pay 5.0 (5.4) 5.2 (7.2) 5.1 (6.3) 0.9123 % Medicare 20.0 (15.3) 21.6 (15.2) 20.8 (13.8) 0.6977 % Medicaid 20.0 (15.3) 23.9 (22.2) 22.1 (19.2) 0.4800 Patient race* % White 69.9 (14.7) 71.0 (29.2) 70.4 (23.0) 0.8783 % Black 8.0 (9.2) 4.7 (5.4) 6.2 (7.6) 0.1375 % Other race 22.1 (16.3) 27.7 (16.2) 25.1 (22.7) 0.4005 Patient ethnicity (% Hispanic), n = 44 24.8 (17.4) 19.0 (22.3) 21.9 (20.0) 0.3447 Patient gender (% male), n = 45 46.6 (7.7) 45.0 (6.8) 45.8 (7.2) 0.4744 P-values for categorical variables obtained from χ2 tests for differences between study arms; P-values for continuous variables obtained from t test for differences between study arms.
↵*Separate question for each category with a continuous response.
Abbreviations: PF, Practice facilitator; SD, Standard deviation.
Baseline 9-Month Variable Mean (95% CI) Mean (95% CI) P-value Overall summed SBI/RT implementation score** 5.9 (4.8, 6.9) 12.7 (11.5, 13.8) <0.0001 Process for UAU screening** 1.4 (1.1, 1.6) 2.7 (2.4, 2.9) <0.0001 Process for reviewing and interpreting UAU screening result** 1.2 (0.9, 1.4) 2.6 (2.4, 2.9) <0.0001 Process for + Screen results** 1.0 (0.8, 1.3) 2.6 (2.3, 2.8) <0.0001 Process for routinely providing feedback and brief intervention** 1.2 (0.9, 1.5) 2.5 (2.2, 2.7) <0.0001 Process for providing care following + UAU screening result** 1.1 (0.9, 1.4) 2.4 (2.1, 2.7) <0.0001 Other survey questions Baseline 9-Month Total n = 51 Total n = 43 Variable n (%) n (%) P-value* Which patients are screened? All patients ages 18 and above 30 (59%) 35 (81%) 0.0184 All patients with different age range 6 (12%) 1 (2%) 0.0588 Patients with a particular condition 2 (4%) 2 (5%) 1.0 Patients presenting for a health maintenance/preventive care visit 13 (25%) 20 (47%) 0.0290 Patients participating in telehealth or phone appointments 4 (8%) 2 (5%) 0.4142 Patients participating in web-based/ tablet/ 2 (4%) 2 (5%) 1.0 application-based appointments How often are eligible patients screened? Your best estimate is fine. Up to 25% of the time 3 (8%) 0 (0%) 26% to 50% of the time 12 (32%) 11 (26%) 51% to 75% of the time 16 (42%) 13 (30%) 76% of the time or more 7 (18%) 19 (44%) 0.0040 The practice provides the following support to help patients with unhealthy drinking or alcohol use disorder “Yes” “Yes” P-value N (%) N (%) 1, Brief intervention/brief treatment provided by internal clinician 33 (65%) 41 (95%) 0.0010 2, Brief intervention/brief treatment provided by internal behavioral health provider 18 (35%) 23 (53%) 0.0209 Any brief intervention 34 (67%) 42 (98%) 0.0005 3, Provide patient educational materials 12 (24%) 37 (86%) <0.0001 4, Refer to external medical or behavioral health provider 23 (45%) 35 (81%) <0.0001 5, Refer to self-help, mutual support, or peer support groups 20 (39%) 34 (79%) <0.0001 6, Refer to external treatment program (inpatient, outpatient, residential) 21 (41%) 30 (70%) 0.0013 Any external referral for treatment (“yes” to 4 or 6 above) 26 (51%) 37 (86%) 0.0002 7, Prescribe medication for alcohol use disorders (prescribe medication without behavioral health intervention) 21 (41%) 31 (72%) 0.0029 8, Prescribe medication-assisted therapy (prescribe medication with behavioral health intervention) 15 (29%) 27 (63%) 0.0043 Any provision of MAT 21 (41%) 33 (77%) 0.0011 ↵*Adjusted for visits per week and practice type (safety-net, hospital owned, rural health center, independent).
↵**SBIRT implementation questions are scored 0 (not started at this time) to 3 (full implementation). The total score is the sum of the scores on the individual items; higher scores mean greater implementation. The n’s (n = 51, n = 43) refer to the number of randomized practices that submitted baseline and 9-month surveys respectively.
±McNemar’s test on practices with both baseline and follow-up.
Abbreviations: SBI, Screening and Brief Intervention; RT, Referral to Treatment; UAU, Urinalysis and Urine Culture; MAT, Medication-Assisted Treatment; SBIRT, Screening Brief Intervention and Referral to Treatment.
- Table 5.
SBIRT Metrics Results: Adjusted Estimates over Time (Previous 3-Months Before Reporting Period)
Baseline 3 Months 6 Months 9 Months SBIRT Survey Study Arm Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) P-value* Screened Both groups 99.6 (64.3, 154.3) 233.2 (150.3, 361.6) 368.7 (236.7574.5) 337.4 (216.2, 526.7) Time: <0.0001 Positive screen Both groups 5.6 (3.2, 9.8) 13.2 (7.6, 23.0) 23.6 (13.5, 41.0) 27.4 (15.8, 47.7) Time: <0.0001 AUD diagnosis Both groups 0.29 (0.11, 0.71) 0.76 (0.32, 1.78) 1.06 (0.45, 2.48) 1.32 (0.57, 3.08) Time: 0.0006 Brief intervention Both groups 0.3 (0.1, 0.7) 0.9 (1.2, 5.4) 4.1 (2.0, 8.5) 4.0 (1.9, 8.3) Time: <0.0001 Referred Both groups 0.1 (0.1, 0.5) 0.3 (0.1, 0.6) 0.3 (0.2, 0.7) 0.3 (0.2, 0.7) Time: 0.9284 MAT Both groups 0.9 (0.5, 1.5) 1.5 (0.9, 2.4) 1.8 (1.1, 2.9) 2.6 (1.6, 4.2) Time: 0.0007 ↵*Analyses adjusted for average visits per week and practice ownership (clinician, safety-net, hospital-owned, rural health center); P-value refers to change over time across all timepoints in longitudinal analyses.
Abbreviations: SBIRT, Screening Brief Intervention and Referral to Treatment; MAT, Medication-Assisted Treatment; AUD, Alcohol Use Disorder.
