Stone Alanna, Wamsley Maria, O'Sullivan Patricia, Satterfield Jason, Satre Derek D, Julian Katherine
a Division of General Medicine and Geriatrics, Department of Medicine , Emory University , Atlanta , Georgia , USA.
b Division of General Internal Medicine, Department of Medicine , University of California , San Francisco, San Francisco , California , USA.
Subst Abus. 2017 Jan-Mar;38(1):31-34. doi: 10.1080/08897077.2016.1264533. Epub 2016 Nov 29.
Screening, brief intervention, and referral to treatment (SBIRT) is a practical means to address substance misuse in primary care. Important barriers to implementing SBIRT include adequacy of training and provider confidence as well as logistical hurdles and time constraints. A faculty development initiative aimed at increasing SBIRT knowledge and treatment of substance use disorders (SUDs) should lead to increased use of SBIRT by faculty and the residents they teach. This study examined how a faculty development program to promote SBIRT influenced faculty practice and resident teaching.
This was a cross-sectional study of faculty exposed to multiple SBIRT educational interventions over a 5-year period in an academic faculty-resident general medicine practice. Participants completed a brief online survey followed by a semistructured interview. Quantitative responses were examined descriptively. Qualitative questions were reviewed to identify key themes.
Fifteen of 29 faculty (52%) completed the survey and 13 (45%) completed the interviews regarding faculty development interventions. Faculty thought that SBIRT was an important skill and had confidence in screening for substance use disorders, although confidence in making treatment referrals and prescribing pharmacotherapy were rated lower. Many faculty reported screening more frequently for SUDs after attending faculty development sessions. However, several reported that the training did not improve their SBIRT teaching to residents during clinic precepting sessions. To improve uptake of SBIRT, a majority of faculty recommended electronic health record (EHR) alerts.
SBIRT is a highly valued set of skills, and training may enhance rates of screening for substance misuse. However, participants did not report a substantial change in SBIRT teaching as a result of faculty development. In the future, small, targeted faculty development sessions, potentially involving strategies for using the electronic health record (EHR), may be an effective way to enhance primary care SBIRT skills.
筛查、简短干预及转介治疗（SBIRT）是在初级保健中解决药物滥用问题的一种实用方法。实施SBIRT的重要障碍包括培训的充分性、提供者的信心以及后勤障碍和时间限制。一项旨在增加SBIRT知识和药物使用障碍（SUD）治疗的师资发展倡议应会促使教师及其所教授的住院医师更多地使用SBIRT。本研究考察了一项促进SBIRT的师资发展计划如何影响教师的实践和对住院医师的教学。
这是一项横断面研究，研究对象是在一个学术性教师-住院医师综合内科实践中，在5年期间接受了多次SBIRT教育干预的教师。参与者先完成一份简短的在线调查，随后进行一次半结构化访谈。对定量回答进行描述性分析。对定性问题进行审查以确定关键主题。
29名教师中有15名（52%）完成了调查，13名（45%）完成了关于师资发展干预的访谈。教师们认为SBIRT是一项重要技能，并且对筛查药物使用障碍有信心，尽管在进行治疗转介和开具药物治疗处方方面的信心得分较低。许多教师报告称，参加师资发展课程后，他们对SUD的筛查更为频繁。然而，有几位教师表示，培训并没有改善他们在临床带教课程中对住院医师的SBIRT教学。为了提高SBIRT的采用率，大多数教师推荐使用电子健康记录（EHR）提醒。
SBIRT是一套备受重视的技能，培训可能会提高药物滥用筛查率。然而，参与者并未报告师资发展使SBIRT教学有实质性变化。未来，小型的、有针对性的师资发展课程，可能涉及使用电子健康记录（EHR）的策略，可能是提高初级保健SBIRT技能的有效方法。
