Department of Obstetrics and Gynecology, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
Maine Medical Center Research Institute Center for Outcomes Research and Evaluation, Scarborough, ME, USA.
Matern Child Health J. 2020 Apr;24(4):412-418. doi: 10.1007/s10995-020-02892-9.
Universal screening for substance use during pregnancy, brief intervention, and referral to treatment (SBIRT) is recommended by ACOG and the USPSTF. Here we present the implementation of SBIRT into the electronic health record (EHR) to inform clinical intervention and collect data on the prevalence of substance use during pregnancy at three prenatal clinics.
A literature-based SBIRT instrument was developed. The tool was integrated into the EHR of a resident Ob/Gyn clinic, an MFM practice, and an Ob/Gyn generalist practice at our institution, an academic, tertiary care medical center in an urban area, and automated reports of aggregate retrospective EHR data were used to monitor patient responses to SBIRT over time. Data reports included patient responses to screening for substance use, brief intervention, and referral to treatment from January to December 2018 RESULTS: An interprofessional team of health care providers and systems analysts guided the SBIRT implementation process. As of December 2018, overall SBIRT performance during prenatal care encounters was 1797/2619 (69%), 432/1350 (32%), and 1290/1518 (85%) in the resident clinic, MFM practice, and generalist practice, respectively. Eighty (5.1%) women in the resident clinic, 2 (0.5%) in the MFM practice and 14 (1%) in the generalist practice reported past or present substance use.
Integrating universal SBIRT into prenatal care using the EHR requires a multi-disciplinary approach. The SBIRT tool facilitates reportable substance use screening, brief intervention, and referral to treatment during prenatal care. Future reports will further characterize substance use in our prenatal practices and inform intervention strategies in this population.
ACOG 和 USPSTF 建议在妊娠期间进行物质使用的普遍筛查、简短干预和转介治疗（SBIRT）。在这里，我们将 SBIRT 引入电子健康记录（EHR），以告知临床干预，并收集三个产前诊所妊娠期间物质使用的患病率数据。
基于文献的 SBIRT 工具得到了开发。该工具被整合到我们机构的一个住院妇产科诊所、一个妇产科专家诊所和一个妇产科普通诊所的 EHR 中，该机构是一个位于城市地区的学术性、三级保健医疗中心，并使用自动汇总回顾性 EHR 数据报告来监测患者随时间对 SBIRT 的反应。数据报告包括患者对物质使用筛查、简短干预和转介治疗的反应，时间范围为 2018 年 1 月至 12 月。
一个由医疗保健提供者和系统分析师组成的跨专业团队指导了 SBIRT 的实施过程。截至 2018 年 12 月，在住院诊所、妇产科专家诊所和妇产科普通诊所中，产前保健就诊期间的总体 SBIRT 表现分别为 1797/2619（69%）、432/1350（32%）和 1290/1518（85%）。在住院诊所中，有 80 名（5.1%）女性、妇产科专家诊所中 2 名（0.5%）和妇产科普通诊所中 14 名（1%）报告过去或现在有物质使用情况。
使用 EHR 将普遍的 SBIRT 纳入产前保健需要多学科方法。SBIRT 工具促进了可报告的物质使用筛查、简短干预和转介治疗，在产前保健期间。未来的报告将进一步描述我们产前实践中的物质使用情况，并为该人群的干预策略提供信息。
