scholarly journals Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kelli Thoele ◽  
Laura Moffat ◽  
Stephanie Konicek ◽  
Monika Lam-Chi ◽  
Erica Newkirk ◽  
...  
Keyword(s):  
Primary Care ◽  
Brief Intervention ◽  
Scoping Review ◽  
Implementation Strategies ◽  
Implementation Process ◽  
The United States ◽  
Healthcare Settings ◽  
Primary Care Settings ◽  
Implementation Outcomes ◽  
Prevention And Treatment

Abstract Background Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. Methods A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. Results Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. Discussion In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.

scholarly journals Using web-based technology to improve depression screening in primary care settings

2021 ◽  
Vol 10 (1) ◽  
pp. e001028
Author(s):  
Jessica Jeffrey ◽  
Minh-Chau T Do ◽  
Nastassia Hajal ◽  
Yu-Hsiang Lin ◽  
Rachel Linonis ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Assessment Tool ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Systematic Screening ◽  
Web Based ◽  
Systems Planning ◽  
Primary Care Settings ◽  
Patient Health

BackgroundGiven the high rates at which patients present with behavioural health (BH) concerns in primary care (PC), this setting has become the de facto mental health system. As a result, screening for depression and other BH conditions in PC has become a critical target for improving patient outcomes. However, integration of screening into busy PC workflows can be challenging due to barriers such as limited time and resources.MethodologyA digital, cloud-based BH assessment tool, which included electronic health record enhancements, was developed and implemented in two urban PC practices as a prelude to a planned larger-scale implementation. The implementation strategies included a reorganisation of workflows within the PC setting, comprehensive training for staff and PC physicians, and institution of an incentive programme for PC clinic managers. To examine whether the introduction of the cloud-based BH assessment tool and associated implementation strategies was associated with increased screening rates, we compared rates of screening from January through June 2017 to rates of screening from January through June 2018 (subsequent to implementation). We also examined BH symptomatology reported by patients in PC.ResultsFollowing the implementation process, rate of BH screening with Patient Health Questionnaire-2 (PHQ-2) increased from 50.5% to 57% (p<0.00000000000000022) and rates of subsequent screening with PHQ-9, for those scoring at risk, defined as a score of ≥1, on PHQ-2, increased from 34.5% to 91.4% (p<0.00000000000000022). Additionally, high rates of ‘moderate’ and ‘severe’ symptoms of depression (40.3%), anxiety (42.6%) and substance use (26.7% alcohol; 31.2% other substance use) were observed among PC patients.ConclusionsResults suggest that a comprehensive implementation plan, including digitisation of BH assessment, reduced the burden of systematic screening. High rates of BH symptomatology underscore the need for comprehensive BH assessment and systems planning to address the high need for BH services among PC patients.

scholarly journals Using community-based participatory research in improving the management of hypertension in communities: A scoping review

2020 ◽  
Vol 62 (1) ◽  
Author(s):  
Pugie T. Chimberengwa ◽  
Mergan Naidoo
Keyword(s):  
Primary Care ◽  
Participatory Research ◽  
Scoping Review ◽  
Community Based Participatory Research ◽  
The United States ◽  
Academic Community ◽  
Community Based ◽  
Primary Care Settings ◽  
A Priority ◽  
The Impact

Background: Hypertension (HT) is a key contributor to cardiovascular diseases (CVDs). The improved management of HT in the community and primary care settings should be a priority for low- and middle-income countries (LMICs). Improving the prevention and management of HT in primary care settings should also be a priority for developing countries. There is a need for more studies using community-based approaches that show the impact of these programmes on HT outcomes, which may motivate policymakers to invest in such approaches. The ward-based outreach team or village healthcare worker models were meant to provide such approaches, but many of these have become lower levels of curative care. We conducted a scoping review to examine how community-based participatory research (CBPR) was being used to improve HT management.Methods: Several electronic databases were searched, namely PubMed, MEDLINE, Google Scholar and Web of Science, generating 798 references. The publications were screened through several rounds. Data were extracted and imported into a Microsoft Excel spreadsheet, numerically summarised and qualitatively analysed.Results: Nine articles were included. These publications originated from the United States, Colombia, Canada, China, South Africa and Zimbabwe. Mixed methods, qualitative, randomised control trials and quasi-experimental studies were used to implement CBPR in the studies included. All the studies addressed complex health problems and inequities among the minorities utilising multiple stakeholder participation. Academic–community coalitions were formed, which enabled engagement and sharing of power equitably. As a result, there was acceptability and sustainability of interventions.Conclusion: A CBPR framework can be used to define the context, group dynamics, implementation and outcomes of HT. It is possible to apply CBPR in HT management to appropriately address health disparities while emphasising a community-driven approach. To achieve this, tailored health education platforms should be developed and implemented.

scholarly journals Ten years of implementation outcome research: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e049339
Author(s):  
Rebecca Lengnick-Hall ◽  
Enola K Proctor ◽  
Alicia C Bunger ◽  
Donald R Gerke
Keyword(s):  
Scoping Review ◽  
Research Agenda ◽  
Empirical Studies ◽  
Implementation Strategies ◽  
Professional Associations ◽  
Healthcare Settings ◽  
Implementation Outcomes ◽  
Scoping Reviews ◽  
Review Protocol ◽  
Meta Analyses

IntroductionA 2011 paper proposed a working taxonomy of implementation outcomes, their conceptual distinctions and a two-pronged research agenda on their role in implementation success. Since then, over 1100 papers citing the manuscript have been published. Our goal is to compare the field’s progress to the originally proposed research agenda, and outline recommendations for the next 10 years. To accomplish this, we are conducting the proposed scoping review.Methods and analysisOur approach is informed by Arksey and O’Malley’s methodological framework for conducting scoping reviews. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We first aim to assess the degree to which each implementation outcome has been investigated in the literature, including healthcare settings, clinical populations and innovations represented. We next aim to describe the relationship between implementation strategies and outcomes. Our last aim is to identify studies that empirically assess relationships among implementation and/or service and client outcomes. We will use a forward citation tracing approach to identify all literature that cited the 2011 paper in the Web of Science (WOS) and will supplement this with citation alerts sent to the second author for a 6-month period coinciding with the WOS citation search. Our review will focus on empirical studies that are designed to assess at least one of the identified implementation outcomes in the 2011 taxonomy and are published in peer-reviewed journals. We will generate descriptive statistics from extracted data and organise results by these research aims.Ethics and disseminationNo human research participants will be involved in this review. We plan to share findings through a variety of means including peer-reviewed journal publications, national conference presentations, invited workshops and webinars, email listservs affiliated with our institutions and professional associations, and academic social media.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Who are we missing with EHR-based smoking cessation treatments? A descriptive study of patients who smoke and do not regularly visit primary care clinics

2020 ◽  
Vol 15 (4) ◽  
pp. 175-180
Author(s):  
Margaret Nolan ◽  
Deejay Zwaga ◽  
Danielle McCarthy ◽  
Christian Kastman ◽  
Timothy Baker ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
The United States ◽  
Primary Care Visit ◽  
Patient Portal ◽  
The Past ◽  
Healthcare Settings ◽  
Care Visit ◽  
Tobacco Treatment

AbstractIntroductionMost tobacco treatment efforts target healthcare settings, because about 75% of smokers in the United States visit a primary care provider annually. Yet, 25% of patients may be missed by such targeting.AimsTo describe patients who smoke but infrequently visit primary care – their characteristics, rates of successful telephone contact, and acceptance of tobacco treatment.MethodsTobacco Cessation Outreach Specialists ‘cold-called’ those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, electronic health record (EHR) patient-portal status and outreach outcomes were reported.ResultsOf 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers (42 vs. 44 years, P = 0.004; 48% vs. 40% female, P = 0.0002, and 21% vs. 27% some-day, P = 0.003), and less active on the EHR patient portal (33% vs. 40%, P = 0.001).ConclusionsA substantial proportion of patients who smoke are missed by traditional tobacco treatment interventions that require a primary care visit, yet many are receptive to quit smoking treatment offers.

scholarly journals Evaluating the implementation of a primary care intervention to reduce prescriptions of benzodiazepines (BENZORED IV)

2021 ◽  
Author(s):  
Isabel Socias ◽  
Alfonso Leiva ◽  
Haizea Pombo-Ramos ◽  
Ferran Bejarano ◽  
Ermengol Sempere-Verdú ◽  
...  
Keyword(s):  
Primary Care ◽  
Traffic Accidents ◽  
Implementation Strategies ◽  
Developed Countries ◽  
Successful Implementation ◽  
Implementation Climate ◽  
Primary Care Settings ◽  
The Individual

Abstract Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type 1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze facilitator and barriers to implement the intervention to primary care settings.Methods: Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate and analyze the dataResults: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: The complexity in the intervention, the individual Stage of Change and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: the adaptability in the intervention, the external policy and incentives, the implementation climate, the relative priority, the self-efficacy and formally appointed implementation leader engaging. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation.Conclusion: We identified constructs that could explain the variation in the implementation of the intervention, this information is relevant to design successful implementation strategies to implement the intervention.

scholarly journals Brief Intervention for Problem Drug Use in Safety-Net Primary Care Settings

JAMA ◽  
2014 ◽  
Vol 312 (5) ◽  
pp. 492 ◽  
Author(s):  
Peter Roy-Byrne ◽  
Kristin Bumgardner ◽  
Antoinette Krupski ◽  
Chris Dunn ◽  
Richard Ries ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Use ◽  
Brief Intervention ◽  
Safety Net ◽  
Primary Care Settings ◽  
Problem Drug Use ◽  
Problem Drug

Symptoms and Signs of Hemochromatosis in HFE C282Y Homozygotes Identified by Screening in Primary Care.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1545-1545 ◽  
Author(s):  
Gordon D. McLaren ◽  
Christine E. McLaren ◽  
Paul C. Adams ◽  
James C. Barton ◽  
David M. Reboussin ◽  
...  
Keyword(s):  
Primary Care ◽  
Transferrin Saturation ◽  
Joint Stiffness ◽  
Chronic Fatigue ◽  
The United States ◽  
Newly Diagnosed ◽  
Control Subjects ◽  
Primary Care Settings ◽  
Clinical Conditions ◽  
Symptoms And Signs

Abstract Some patients with hemochromatosis (HC) experience fatigue, heart failure or arrhythmias, diabetes mellitus, liver damage, impotence, or arthritis. We examined self-reported symptoms and clinical conditions in persons homozygous for HFE C282Y, the major HC-associated gene mutation, identified in the Hemochromatosis and Iron Overload Screening (HEIRS) Study, a multi-center, multi-ethnic study in which 101,168 adults were recruited from primary care settings. Non-Hispanic Caucasian C282Y homozygotes were compared to participants without HFE C282Y or H63D alleles (controls) with transferrin saturation (TfS) and serum ferritin (SF) levels in the middle half of gender-specific distributions. Evaluation included a medical history, focused physical examination, and repeat SF. Among 44,082 non-Hispanic Caucasian participants screened at five Field Centers in the United States and Canada, 282 persons homozygous for C282Y were identified, comprising three groups: newly-diagnosed cases with normal (N=64) or elevated (N=131) SF (>200 μg/L in women, >300 μg/L in men), and previously-diagnosed cases (N=87). There were 364 non-Hispanic Caucasian controls. Significant differences were observed for six of 38 outcomes. Previously diagnosed C282Y homozygotes and newly diagnosed homozygotes with elevated SF reported significantly more chronic fatigue than controls (p=0.002). All groups of C282Y homozygotes reported weight loss more often than controls (p<0.001). Excessive thirst was reported more often than controls by newly diagnosed C282Y homozygotes, regardless of SF level (p=0.004), but there was no difference in self-reported history of diabetes. Joint stiffness was more common among newly diagnosed C282Y homozygotes with elevated SF than among control subjects (p<0.001). Swelling or tenderness of the second and third metacarpophalangeal joints and increased pigmentation were also more common among previously diagnosed C282Y homozygotes and newly diagnosed homozygotes with elevated SF than among controls (p=0.001 and p=0.002, respectively). The prevalences of manifestations related to liver or heart disease among C282Y homozygotes were not significantly different from controls. There were no differences among the three groups of C282Y homozygotes in the prevalences of any symptoms or clinical conditions. In summary, some symptoms and conditions associated with HC were more prevalent among C282Y homozygotes than among controls. However, C282Y homozygotes identified by screening in primary care settings did not have a higher prevalence of most symptoms and signs associated with HC than control subjects.

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