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Teaching residents screening, brief intervention, and referral to treatment (SBIRT) skills for alcohol use: Using chart-stimulated recall to assess curricular impact

Authors :
Maria Wamsley
Patricia S. O'Sullivan
Scott Steiger
Katherine A. Julian
Michelle Guy
Jason M. Satterfield
Nathaniel Gleason
Source :
Wamsley, MA; Steiger, S; Julian, KA; Gleason, N; O'Sullivan, PS; Guy, M; et al.(2016). Teaching residents screening, brief intervention, and referral to treatment (SBIRT) skills for alcohol use: Using chart-stimulated recall to assess curricular impact. SUBSTANCE ABUSE, 37(3), 419-426. doi: 10.1080/08897077.2015.1127869. UC San Francisco: Retrieved from: http://www.escholarship.org/uc/item/53h037ns, Substance abuse, vol 37, iss 3
Publication Year :
2016
Publisher :
SAGE Publications, 2016.

Abstract

Background: Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents’ use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). Methods: Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. Results: Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. Conclusions: More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

Details

ISSN :
15470164 and 08897077
Volume :
37
Database :
OpenAIRE
Journal :
Substance Abuse
Accession number :
edsair.doi.dedup.....001cf9a0b4beee6bd874e37aa928a824
Full Text :
https://doi.org/10.1080/08897077.2015.1127869