Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
School of Education, The University of North Carolina at Greensboro, 1300 Spring Garden Street, Greensboro, NC 27412, United States of America.
J Subst Abuse Treat. 2022 Jan;132:108510. doi: 10.1016/j.jsat.2021.108510. Epub 2021 May 31.
We analyzed the association of Screening, Brief Intervention, and Referral to Treatment (SBIRT) with hospitalizations, emergency department (ED) visits, and related costs, when administered to inpatients with substance misuse or disordered use by professional mental health counselors.
Our study used retrospective program and health records data and a difference-in-differences design with propensity score covariates. The study population consisted of hospital inpatients admitted to integrated care services staffed by physicians, nurses, and mental health counselors. The intervention group consisted of patients selected for intervention based on substance use history and receiving SBIRT (n = 1577). Patients selected for intervention but discharged before SBIRT administration (n = 618) formed the comparison group. The outcome variables were hospitalization and ED visits costs and counts. Costs of hospitalizations and ED visits were combined to allow sufficient data for analysis, with counts treated similarly. Patient-level variables were substance use type and substance use severity. A cluster variable was inpatient clinical service. Zero-censored and two-part logistic and generalized linear models with robust standard errors tested the association of SBIRT interventions with the outcomes.
For the full study population of patients using alcohol, illicit drugs, or both, SBIRT administered by mental health counselors was not associated with changes in hospitalizations and ED visits. For patients with alcohol misuse or disordered use, SBIRT by mental health counselors was associated an odds ratio of 0.32 (p < .001) of having subsequent hospitalizations or ED visits. For patients with alcohol use who did return as hospital inpatients or to the ED, SBIRT by counselors was associated with a reduction in costs of $2547 per patient (p < .001) and with an incidence rate ratio of 0.57 for counts (p = .003).
Our results suggest that professional mental health counselors on inpatient integrated care teams may provide SBIRT effectively for patients with misuse and disordered use of alcohol, reducing the likelihood of future healthcare utilization and costs.
我们分析了由专业心理健康辅导员对有物质使用障碍或滥用问题的住院患者实施筛查、简短干预和转介治疗（SBIRT）与住院、急诊就诊（ED）及其相关费用之间的关联。
本研究使用回顾性项目和健康记录数据，并采用倾向评分协变量的差分法设计。研究人群包括由医生、护士和心理健康辅导员组成的综合护理服务收治的住院患者。干预组由根据物质使用史选择并接受 SBIRT 的患者组成（n=1577）。选择接受 SBIRT 但在干预前出院的患者（n=618）作为对照组。因变量为住院和 ED 就诊费用和就诊次数。将住院和 ED 就诊费用合并，以便进行充分分析，就诊次数也采用类似方法处理。患者层面的变量为物质使用类型和物质使用严重程度。聚类变量为住院患者临床服务。采用零截断和两部分逻辑回归及广义线性模型，使用稳健标准误差检验 SBIRT 干预与结果之间的关联。
对于使用酒精、非法药物或两者的所有患者，心理健康辅导员实施的 SBIRT 与住院和 ED 就诊次数的变化无关。对于有酒精滥用或障碍性使用的患者，心理健康辅导员实施的 SBIRT 与随后住院或 ED 就诊的比值比为 0.32（p<.001）。对于返回住院或 ED 的有酒精使用障碍的患者，辅导员提供的 SBIRT 与每位患者减少 2547 美元的费用相关（p<.001），并且就诊次数的发生率比为 0.57（p=.003）。
我们的结果表明，住院综合护理团队中的专业心理健康辅导员可能会有效地为有酒精滥用和障碍性使用问题的患者提供 SBIRT，降低未来医疗保健利用和费用的可能性。
