VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 900, New Haven, CT 06511, USA.
Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 900, New Haven, CT 06511, USA.
J Subst Abuse Treat. 2019 Apr;99:1-7. doi: 10.1016/j.jsat.2019.01.007. Epub 2019 Jan 9.
Electronic delivery of Screening, Brief Intervention, and Referral to Treatment (e-SBIRT) may be a low-cost and high-reach method for screening and brief intervention in health care settings. However, its relative acceptability, ability to build a therapeutic alliance, and delivery of key intervention components compared to in-person SBIRT (SBIRT) is unclear. The association of these factors with intervention outcomes is also not known. We compared SBIRT and e-SBIRT on satisfaction, alliance, and receipt of intervention components, and evaluated the extent to which these intervention dimensions were related to later substance use. Data were collected as part of a randomized clinical trial (N = 439) examining SBIRT, e-SBIRT, and enhanced usual care for childbearing-aged women in two reproductive healthcare clinics (see Martino et al. (2018) for main trial findings). Participants receiving SBIRT or e-SBIRT (N = 270) rated satisfaction and alliance following a single-session, brief intervention, based on motivational interviewing that targeted hazardous substance use (tobacco, alcohol, illicit drugs and prescribed medications). Trained raters coded audio-recorded SBIRT sessions for the presence of six major intervention components, and evaluated the occurrence of these components in the e-SBIRT software. Overall, participants in both groups reported strong satisfaction (on average, "considerably" to "extremely" satisfied) and perceived working alliance (on average, "very often" to "always" allied). SBIRT participants provided higher overall alliance ratings, felt more encouraged to make their own decisions, and rated the intervention's likely helpfulness to other women higher. Fewer e-SBIRT participants received intervention components focusing on personalized feedback, developing importance of and confidence in making changes to substance use, and developing a plan to change, compared to SBIRT participants. However, e-SBIRT participants were equally or more likely to receive components seeking to help them understand their use, discussing reasons for use, and summarizing and supporting what the patients elected to do. Notably, satisfaction, alliance, and number of intervention components received were not associated with total days of substance use. Although we found no evidence that the intervention characteristics evaluated in this study were associated with outcomes, acceptability and alliance may have other important implications. Findings suggest areas for improvement with respect to e-SBIRT satisfaction and alliance formation. ClinicalTrials.govregistration number: NCT01539525.
电子筛查、简短干预和转介治疗（e-SBIRT）的传递可能是一种低成本、高效率的医疗保健环境筛查和简短干预方法。然而，与面对面的 SBIRT（SBIRT）相比，其相对可接受性、建立治疗联盟的能力以及关键干预措施的传递情况尚不清楚。这些因素与干预结果的关系也尚不清楚。我们比较了 SBIRT 和 e-SBIRT 在满意度、联盟和干预措施的接受情况方面的差异，并评估了这些干预维度与随后的物质使用之间的关系。这些数据是作为一项随机临床试验（N=439）的一部分收集的，该试验检查了两种生殖保健诊所中生育年龄妇女的 SBIRT、e-SBIRT 和增强型常规护理（请参阅 Martino 等人（2018 年）了解主要试验结果）。接受 SBIRT 或 e-SBIRT（N=270）的参与者根据针对危险物质使用（烟草、酒精、非法药物和规定药物）的动机访谈，在单次简短干预后对满意度和联盟进行了评估。经过培训的评估人员对音频记录的 SBIRT 会议进行了编码，以确定六个主要干预措施的存在，并评估了这些措施在 e-SBIRT 软件中的出现情况。总体而言，两组参与者的满意度均很高（平均为“相当”到“非常”满意），对工作联盟的看法也很高（平均为“非常经常”到“总是”结盟）。SBIRT 参与者的整体联盟评分更高，感到更受鼓励做出自己的决定，并且对干预对其他女性的帮助程度评价更高。与 SBIRT 参与者相比，接受个性化反馈、发展对改变物质使用的重要性和信心以及制定改变计划等重点关注个性化反馈、发展对改变物质使用的重要性和信心以及制定改变计划的干预措施的 e-SBIRT 参与者较少。然而，e-SBIRT 参与者同样或更有可能接受帮助他们了解自己使用情况、讨论使用原因以及总结和支持患者选择的干预措施。值得注意的是，满意度、联盟和接受的干预措施数量与物质使用的总天数无关。尽管我们没有发现这项研究中评估的干预措施特征与结果相关的证据，但可接受性和联盟可能具有其他重要意义。研究结果表明，在 e-SBIRT 满意度和联盟形成方面还有改进的空间。临床试验注册编号：NCT01539525。
