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Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments
 

Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments

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Georgia Basics: Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments ...

Georgia Basics: Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments

Presented by:
Gabriel P. Kuperminc, Ph.D
Professor of Psychology
Georgia State University

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  • This diagram helps explain the patient flow in the 2 ga emergency departments, and also shows you the breakdown in the delivery of services.

Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments Presentation Transcript

  • Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments Gabriel P. Kuperminc, Ph.D Professor of Psychology Georgia State University
  • Outline • Adult patients in urban emergency depts • SBIRT – A public health approach to addressing alcohol and substance misuse • How does it work? • Does it make a difference? • Can it be sustained?
  • Urban Emergency Department Patients • Conditions of Risk – High rates of poverty, housing instability – Lack of consistent health care, unmet needs – Behavioral risks (e.g., alcohol, drug use) often associated with health concerns • ED as “Teachable Moment” – Failure to help patients make the connection as lost opportunity – When alcohol/drug use does come up, usually focus on blaming pt for poor choices, need for abstinence
  • What is SBIRT? • Screening • Brief Intervention • Referral to Treatment • Initiative of Substance Abuse and Mental Health Services Administration (SAMHSA) – Cooperative agreements with states (4 cohorts, 20+ projects to date) – Demonstration projects intended to show effectiveness and sustain beyond grant period
  • Georgia BASICS • Overview – Routine screening for risky drinking, substance use – Motivational Interviewing (15-30 minutes) to discuss motivation for change, set goals – Availability of alternatives incl. additional therapy, referral to treatment • Settings – Grady Health System (Atlanta) – Medical Center of Central Georgia (Macon)
  • Risky Drinking
  • Patient Enters ED Nurse Health Educators 54% LowModerate Risk BI BI = Brief Intervention BT = Brief Therapy RT = Referral to Treatment 3 Question Prescreen: 25% Positive 60% of positive prescreens receive ASSIST Full Screen 7% High Risk BI + BT 32% Screening Feedback 7% Very High Risk BI+ RT 10% Sample enrolled For 6 month Follow Up
  • (Nearly) Final Numbers … Services Provided Enrolled in Study (Tx sample) Screening/Feedback Brief Intervention (BI) 150,452 23,270 --728 BI + Brief Therapy (BT) BI + Referral to Tx (RT) Total 2,933 3,344 179,999 172 176 1,076 * Note: Pts. enrolled in study via random selection from those receiving services.
  • Analysis Sample Control (N = 1737) Intervention ( N =724) 11.94 11.88 42 42 % Female 34% 29% % African-American 75% 73% % Employed full/part time 34% 32% % Unstably housed/Homeless 39% 45% Monthly wage (average) $885 $643 Education (years) Age (average) Notes: (1) Comparison patients received screening/assessment but no services during 3month period prior to initiating service delivery. (2) Six month follow-ups completed with appr. 50% of Comparison and 65% of Intervention patients.
  • Reductions in Risky Drinking • Intervention patients 46% less likely than Controls to report moderate/high frequency drinking by follow-up. • One in four Intervention pts, and one in five Control patients reduced drinking from moderate/high to low frequency. • Almost twice as many Control patients as Intervention patients increased their drinking frequency. Percentage of Moderate to Heavy Drinkers by Intervention Status 80% 75% 70% 65% Intervention Control 60% 55% 50% 45% 40% Time 1 Time 2
  • Increased Engagement in Treatment • Highest Risk Pts referred to treatment facilities in the local community • 15-30% of these pts. engaged treatment by 3 months after receiving SBIRT services (MCCG) • Higher than national estimate of 5%
  • Improvements in Mental Health • Intake scores placed pts in lowest quartile of U.S. population for mental health • By follow up – Intervention pts improved to 40th percentile – Controls declined to 7th percentile Change in Mental Health Composite Score by Intervention Status 60 55 50 45 40 35 30 Interventio n Control 25 Intake Follow-up
  • Improved Social Support Networks • Intervention and Control Pts. similar levels of social support at intake • Intervention pts. improved slightly • Controls declined substantially Perceived Social Support at 6-Month Follow-Up 2 1.5 Control 1 Intervention 0.5 0 Partner Parents Siblings Other Family
  • Potential Cost Savings Average number of ED visits 6 months before and after target visit 3.5 Intervention 3 Control 2.5 2 1.5 1 6 months before 6 months after • 1-month sample (248 SBIRT; 170 controls). • Intervention pts had 0.66 fewer ED Visits following SBIRT services vs. Controls • Significant even controlling demographic and health related confounds • Cost savings may outweigh cost of services, esp given high
  • Conclusions • SBIRT services make a meaningful difference in people’s lives – Reductions in risky drinking – Improvements in other health outcomes • SBIRT services link patients to the care they need and natural support systems – High rates of treatment engagement – Improvements in social support resources • SBIRT is good policy – Reductions in ED visits and hospital admissions point to substantial cost savings
  • Sustaining SBIRT in Georgia? • SBIRT staff not retained at either medical center  • BUT – Trained workforce, including increased expertise in motivational interviewing (MINT) – Broad acceptance of SBIRT practice – Universal screening for alcohol/drugs – Interest in instituting SBIRT/SBI in other settings • Pilot project on electronic SBI in county health dept (collab with CDC) • Integrating MI with linkage to care for HIV+ pts with substance abuse (NIDA proposal) • Mercer College of Medicine integrates SBIRT into residency training (SAMHSA)
  • Thanks to • Funding from Substance Abuse and Mental Health Services Administration (SAMHSA), #TI019545 • GSU Colleagues and Students – Jim Emshoff, Dom Parrott, Jennifer Zorland, Joanna Akin, Lindsey Cochran, Adam Carton, Devin Gilmore, Robyn Borgman, Nick Tarantino, NerissaGermain, Doyanne Darnell, Natalie Wilkins, and others • Georgia Division of Behavioral Health and Developmental Disabilities: Steve O’Neill • Partners at Grady Health System and Medical Center of Central Georgia – Too many to name!
  • Questions?