Babor Thomas F, Del Boca Frances, Bray Jeremy W
University of Connecticut School of Medicine, Farmington, CT, USA.
University of North Carolina at Greensboro, Greensboro, NC, USA.
Addiction. 2017 Feb;112 Suppl 2:110-117. doi: 10.1111/add.13675.
This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA).
Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings.
SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges.
The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.
本文描述了一项由美国药物滥用和精神健康服务管理局（SAMHSA）资助的全国筛查、简短干预和转介治疗（SBIRT）示范项目跨站点评估的主要结果及其对公共卫生的影响。
两个队列中由SAMHSA资助的11个多站点项目各获得了为期5年的资金，以促进SBIRT的采用和持续实施。SBIRT跨站点评估采用了多方法评估设计，以提供关于SBIRT在各种医疗和社区环境中实施的过程、结果和成本的全面信息。
在接受评估的两个SAMHSA队列中的SBIRT项目筛查了超过100万名患者/客户。SBIRT的实施得益于坚定的领导以及使用药物使用专家而非普通医学专家来提供服务。尽管结果评估的准实验性质不允许进行因果推断，但几乎每项药物使用指标的前后差异在临床上都具有意义且在统计学上具有显著性。更高的干预强度与药物使用的更大降幅相关。简短干预和简短治疗均与积极结果相关，但对于大多数药物而言，简短干预更具成本效益。在最初的资助结束后，69个（67%）原始绩效站点对SBIRT服务提供进行了调整和重新设计。有四个因素影响了SBIRT的可持续性：项目支持者的存在、资金的可获得性、系统性变革以及对SBIRT提供者挑战的有效管理。
美国药物滥用和精神健康服务管理局的筛查、简短干预和转介治疗（SBIRT）示范项目成功地适应了酒精和非法药物有害使用早期识别工作的需求。SBIRT是将药物使用障碍管理纳入初级保健和普通医学的一种创新方式。筛查、简短干预和转介治疗的实施与治疗系统公平性、效率和经济性的改善相关。
