Mello Michael J, Baird Janette, Spirito Anthony, Scott Kelli, Zonfrillo Mark R, Lee Lois K, Kiragu Andrew, Christison-Lagay Emily, Bromberg Julie, Ruest Stephanie, Pruitt Charles, Lawson Karla A, Nasr Isam W, Aidlen Jeremy T, Maxson Robert Todd, Becker Sara
Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA.
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Subst Use. 2024 Aug 21;18:29768357241272356. doi: 10.1177/29768357241272356. eCollection 2024 Jan-Dec.
Screening, brief intervention, and referral to treatment (SBIRT) for adolescent alcohol and drug (AOD) use is recommended to occur with adolescents admitted to pediatric trauma centers. Most metrics on SBIRT service delivery only reference medical record documentation. In this analysis we examined changes in adolescents' perception of SBIRT services and concordance of adolescent-report and medical record data, among a sample of adolescents admitted before and after institutional SBIRT implementation.
We implemented SBIRT for adolescent AOD use using the Science to Service Laboratory implementation strategy and enrolled adolescents at 9 pediatric trauma centers. The recommended clinical workflow was for nursing to screen, social work to provide adolescents screening positive with brief intervention and referral to their PCP for continued AOD discussions with those. Adolescents screening as high-risk also referred to specialty services. Adolescents were enrolled and contacted 30 days after discharge and asked about their perception of any SBIRT services received. Data were also extracted from enrolled patient's medical record.
There were 430 adolescents enrolled, with 424 that were matched to their EHR data and 329 completed the 30-day survey. In this sample, EHR documented screening increased from pre-implementation to post-implementation (16.3%-65.7%) and brief interventions increased (27.1%-40.7%). Adolescents self-reported higher rates of being asked about alcohol or drug use than in EHR data both pre- and post-implementation (80.7%-81%). Both EHR data and adolescent self-reported data demonstrated low referral back to PCP for continued AOD discussions.
Implementation of SBIRT at pediatric trauma centers was not associated with change in adolescent perceptions of SBIRT, despite improved documentation of delivery of AOD screening and interventions. Adolescents perceived being asked about AOD use more often than was documented. Referral to PCP or specialty care for continued AOD discussion remains an area of needed attention.
Clinicaltrials.gov NCT03297060.
对于入住儿科创伤中心的青少年，建议开展针对青少年酒精和药物使用问题的筛查、简短干预及转介治疗（SBIRT）。大多数关于SBIRT服务提供情况的指标仅参考病历记录。在本分析中，我们在机构实施SBIRT前后收治的青少年样本中，研究了青少年对SBIRT服务认知的变化以及青少年报告数据与病历数据的一致性。
我们采用从科学到服务实验室实施策略对青少年酒精和药物使用问题实施SBIRT，并在9家儿科创伤中心招募青少年。推荐的临床工作流程是由护士进行筛查，社会工作者对筛查呈阳性的青少年进行简短干预，并转介至其初级保健医生处，以便与他们继续讨论酒精和药物使用问题。筛查为高危的青少年也会被转介至专科服务机构。青少年在出院后30天被招募并接受随访，询问他们对所接受的任何SBIRT服务的认知情况。数据也从登记患者的病历中提取。
共招募了430名青少年，其中424名与他们的电子健康记录（EHR）数据匹配，329名完成了30天的调查。在这个样本中，病历记录显示从实施前到实施后，筛查率有所提高（从16.3%提高到65.7%），简短干预率也有所提高（从27.1%提高到40.7%）。青少年自我报告被询问酒精或药物使用情况的比例在实施前后均高于EHR数据记录的比例（80.7% - 81%）。EHR数据和青少年自我报告数据均显示，转介回初级保健医生处继续讨论酒精和药物使用问题的比例较低。
尽管酒精和药物使用筛查及干预的记录有所改善，但儿科创伤中心实施SBIRT与青少年对SBIRT的认知变化无关。青少年感觉自己被询问酒精和药物使用情况的频率高于记录中的频率。转介至初级保健医生或专科护理机构继续讨论酒精和药物使用问题仍是一个需要关注改进的领域。
Clinicaltrials.gov NCT03297060
