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Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments
The document evaluates five years of intervention focusing on risky drinking and substance use among patients in urban emergency departments using the SBIRT model, which includes screening, brief intervention, and referral to treatment. Results indicate that intervention patients had a significant reduction in risky drinking behaviors and improvements in mental health and social support compared to control patients. SBIRT services show promise in linking patients to necessary care while potentially reducing emergency department visits and healthcare costs.
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Georgia BASICS : Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments
- 1. Georgia BASICS : EvaluationResults 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
- 2. Outline • Adult patientsin 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?
- 3. 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
- 4. 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
- 5. 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)
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- 7. 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
- 8. (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.
- 9. 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.
- 10. Reductions in RiskyDrinking • 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
- 11. 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%
- 12. Improvements in MentalHealth • 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
- 13. 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
- 14. Potential Cost Savings Averagenumber 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
- 15. Conclusions • SBIRT servicesmake 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
- 16. Sustaining SBIRT inGeorgia? • 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)
- 17. Thanks to • Fundingfrom 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!
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Editor's Notes
- #8 This diagram helps explain the patient flow in the 2 ga emergency departments, and also shows you the breakdown in the delivery of services.