Vendetti Janice, Bangham Candice, Riba Melissa, Whitmore Corrie, Steinberg Gallucci Karen, Hanson Bridget L, Greece Jacey A
University of Connecticut School of Medicine, Farmington, CT, USA.
Boston University School of Public Health, Boston, MA, USA.
Subst Use Addctn J. 2025 Apr;46(2):461-475. doi: 10.1177/29767342241267074. Epub 2024 Aug 13.
With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system's implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders.
The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework.
Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI.
Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic.
在2018年至2022年期间，在美国疾病控制与预防中心的资助下，4个大型医疗系统（分布于7个州的53个健康中心）为育龄人群提供服务，对工作人员进行了培训，并为酒精筛查与简短干预（SBI）提供实施支持。这项跨站点评估探讨了每个医疗系统实施SBI、减少过量饮酒以及预防产前酒精暴露（PAE）和胎儿酒精谱系障碍的实施方法。
SBIRT（筛查、简短干预及转介治疗）项目矩阵构建了2018年至2022年实施酒精SBI项目的多层次策略。定性和定量数据源在一个逻辑模型的指导下，通过系统层面的过程数据和提供者层面的绩效指标来检查结果。数据分析根据既定框架对定量数据使用频率和均值，对定性数据使用主题分析。
系统内的成功方法包括使用电子健康记录、灵活的实施和工作流程协议、定制的培训和技术援助项目、质量保证反馈回路以及利益相关者的支持。集中式管理结构在跨健康中心标准化实施方面效率较高。分散式管理结构采用量身定制的方法，提高了提供者/工作人员对SBI的接受度。在各个系统中，1259名工作人员（如临床医生、医疗助理）接受了培训，以提供酒精SBI服务，并报告培训前后在进行简短干预的自我效能、PAE咨询技能以及筛查信心方面有所提高。53个（48个提供数据）健康中心实施了酒精SBI，在研究期间筛查了106826名患者，其中10087名酒精使用过量筛查呈阳性的患者中，大多数接受了简短干预。
最大限度地利用技术、在项目实施中采用灵活性以及将流程和协议制度化，改善了工作流程、效率和项目覆盖范围。持续的伙伴关系和利益相关者沟通确定了持续改进、参与以及围绕物质使用筛查可持续性的最佳实践领域，自疫情以来物质使用增加，这些领域至关重要。
