This document discusses screening and brief intervention (SBIRT) for substance use. It provides an overview of SBIRT, including:
- SBIRT uses a stepped care model to provide interventions from brief screening and feedback for low-risk patients to referral to treatment for dependent patients.
- Screening can identify 71% of patients with low or no risk as well as 25% with risky use who could benefit from brief intervention.
- Brief interventions take 10-15 minutes and use motivational interviewing techniques to reduce risks for patients open to change their substance use.
Clinical Track, National Rx Drug Abuse Summit, April 2-4, 2013. Risk Reduction presentation by Dr. Melinda Campopiano, Dr. Jag Khalsa and Dr. Douglas Throckmorton.
Generalized Anxiety and Depression Among Chronic Pain Patients on Opiod Thera...HMO Research Network
This study found:
1) Anxiety and depression among chronic pain patients were associated with higher levels of pain-related impairment, increased healthcare utilization, and poorer overall health.
2) 35.1% of patients met criteria for lifetime opioid dependence, and 25.4% met criteria for current opioid dependence based on the DSM-IV. Patients with a history of anxiety, depression, or other substance dependence disorders were more likely to meet criteria for opioid dependence.
3) The results were very similar when comparing diagnoses of opioid use disorder based on DSM-IV vs. DSM-5 criteria, with a kappa of 0.873, indicating almost perfect agreement between the diagnostic systems.
The document provides an overview of substance use disorders and evidence-based practices for treatment. It notes that 149-272 million people globally used illicit substances in 2009, but only 12-30% of those with substance use disorders receive treatment. Evidence-based practices, which are supported by scientific research, clinical expertise, and feasibility, have been shown to improve treatment outcomes. The document reviews global substance use issues, evidence-based practices that are recommended, and practices that are not recommended.
Problem Gambling and CEP: the role of Facilitationactsconz
Problem Gambling and CEP: the role of Facilitation.
Presented by Mary Anne Cooke, ABACUS Counselling Training and Supervision Ltd at the 2012 Cutting Edge Conference, Wellington, New Zealand.
Started in 2011, Project 25 aims to solve the many difficulties associated not just with chronic homelessness, but especially those who are frequent users of public systems such as local hospitals and law enforcement. In its first year alone, Project 25 demonstrated the following results and these trends have continued into subsequent years. First year results include:
• 56 percent decline in number of hospitalizations
• 58 percent decrease in days spent in the hospital
• 62 percent drop in ambulance rides
• 66 percent reduction in emergency room visits
• 63 percent cut in costs
Benzodiazepines carry risks of abuse and addiction, especially in patients with substance abuse issues, anxiety disorders, or a family history of mental illness. Several studies have found that benzodiazepine use is not safe in patients with substance abuse problems, as it can increase risks of overdose, accidents, and polydrug abuse. For patients prescribed benzodiazepines, close monitoring and limiting prescriptions to 2-4 weeks can help reduce risks of addiction; alternative treatments for anxiety including therapy and herbal remedies should also be considered. Thorough reviews of patient history are necessary before prescribing benzodiazepines to minimize risks of abuse.
This 3-day conference on chronic pain and addiction focused on distinguishing proper pain management from over-prescribing practices that contribute to drug abuse. The objectives were to describe how prescription pain abuse progresses over time and advocate for continued addiction education for pain management providers. The document discussed definitions, statistics on chronic pain and substance use in the US, the spectrum of patient behaviors related to opioid use, prevalence of opioid abuse and addiction among pain patients, significant risk factors for abuse/overdose, and patient risk factors for aberrant behaviors and harm.
Clinical Track, National Rx Drug Abuse Summit, April 2-4, 2013. Risk Reduction presentation by Dr. Melinda Campopiano, Dr. Jag Khalsa and Dr. Douglas Throckmorton.
Generalized Anxiety and Depression Among Chronic Pain Patients on Opiod Thera...HMO Research Network
This study found:
1) Anxiety and depression among chronic pain patients were associated with higher levels of pain-related impairment, increased healthcare utilization, and poorer overall health.
2) 35.1% of patients met criteria for lifetime opioid dependence, and 25.4% met criteria for current opioid dependence based on the DSM-IV. Patients with a history of anxiety, depression, or other substance dependence disorders were more likely to meet criteria for opioid dependence.
3) The results were very similar when comparing diagnoses of opioid use disorder based on DSM-IV vs. DSM-5 criteria, with a kappa of 0.873, indicating almost perfect agreement between the diagnostic systems.
The document provides an overview of substance use disorders and evidence-based practices for treatment. It notes that 149-272 million people globally used illicit substances in 2009, but only 12-30% of those with substance use disorders receive treatment. Evidence-based practices, which are supported by scientific research, clinical expertise, and feasibility, have been shown to improve treatment outcomes. The document reviews global substance use issues, evidence-based practices that are recommended, and practices that are not recommended.
Problem Gambling and CEP: the role of Facilitationactsconz
Problem Gambling and CEP: the role of Facilitation.
Presented by Mary Anne Cooke, ABACUS Counselling Training and Supervision Ltd at the 2012 Cutting Edge Conference, Wellington, New Zealand.
Started in 2011, Project 25 aims to solve the many difficulties associated not just with chronic homelessness, but especially those who are frequent users of public systems such as local hospitals and law enforcement. In its first year alone, Project 25 demonstrated the following results and these trends have continued into subsequent years. First year results include:
• 56 percent decline in number of hospitalizations
• 58 percent decrease in days spent in the hospital
• 62 percent drop in ambulance rides
• 66 percent reduction in emergency room visits
• 63 percent cut in costs
Benzodiazepines carry risks of abuse and addiction, especially in patients with substance abuse issues, anxiety disorders, or a family history of mental illness. Several studies have found that benzodiazepine use is not safe in patients with substance abuse problems, as it can increase risks of overdose, accidents, and polydrug abuse. For patients prescribed benzodiazepines, close monitoring and limiting prescriptions to 2-4 weeks can help reduce risks of addiction; alternative treatments for anxiety including therapy and herbal remedies should also be considered. Thorough reviews of patient history are necessary before prescribing benzodiazepines to minimize risks of abuse.
This 3-day conference on chronic pain and addiction focused on distinguishing proper pain management from over-prescribing practices that contribute to drug abuse. The objectives were to describe how prescription pain abuse progresses over time and advocate for continued addiction education for pain management providers. The document discussed definitions, statistics on chronic pain and substance use in the US, the spectrum of patient behaviors related to opioid use, prevalence of opioid abuse and addiction among pain patients, significant risk factors for abuse/overdose, and patient risk factors for aberrant behaviors and harm.
Intro to Prevention: Psychopharmacology Guest LectureJulie Hynes
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NECP Module 1: Exploring Our Beliefs about Addictionmikewilhelm
This document discusses a neuroscience curriculum on addiction funded by the National Institute on Drug Abuse. It provides an overview of the curriculum's learning objectives which include developing a definition of addiction, understanding risk factors and the neurobiology of addiction, and learning principles of addiction prevention and treatment. It also summarizes statistics on the prevalence, public health impact, and costs of addiction in the United States.
Assessment of substance use disorders 010915Tom Wilson
A presentation on screening and assessment of substance use disorders made to the Leadership in Rehabilitation Counseling Graduate Program at the Boise Campus of the University of Idaho, Boise campus.
The document describes an upcoming conference on addiction in the pharmacy profession from April 2-4, 2013 at the Omni Orlando Resort. The conference aims to help pharmacy professionals identify risk factors for addiction, recognize signs and symptoms of addiction, and describe resources available for those struggling with addiction. It also outlines the structure of monitoring and accountability provided by the Pharmacist Recovery Network for those in recovery. The presentation will be given by Brian Fingerson, president of the Kentucky Professionals Recovery Network, and will include a self-assessment quiz and discussion of why learning about addiction is important for pharmacy professionals.
May 19: Leave No One Behind
Panelists
Brad Alyward, Head Market Access & Health Policy, Indivior
Catherine Boivin, Patient Advocate, CORD
Shona Kinley,Director, Federal Policy & Government Affairs, Novartis
Bennett Lee, Head, Value & Access, Sanofi
Joan Paulin, Patient Advocate, PHA Canada
Trevor Richter, Director of Access and Reimbursement, Gilead
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1. Multiple policies like PDMPs, medication-assisted treatment, and naloxone access need to work together to reduce opioid misuse and overdoses.
2. Programs that educate physicians about prescription drug abuse and its link to heroin, and engage them in prevention, screening, and treatment can help address the epidemic.
3. Expanding access to evidence-based treatment with medications like buprenorphine and naloxone, combined with behavioral therapies, can help manage opioid addiction as a chronic disease
Closing the treatment gap in alcohol dependence thessalonika 2015Antoni Gual
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DataBrief No. 26: Medicaid Managed Care and Long-Term Services and Supports F...The Scan Foundation
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Substance abuse treatment is tailored to help with recovery from drug and alcohol addiction. Comprehensive services are the key to success. Learn more about substance abuse treatment at FindRehabCenters.org and get help finding the appropriate treatment center for you. (877) 322-2450
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1) Compulsory drug treatment centers (CDTCs) in Southeast and East Asia fail to provide effective drug treatment and increase HIV risks, despite growing in number.
2) CDTCs do not use evidence-based treatment methods, have high relapse rates, and violate international human rights standards by involuntarily confining and treating drug users.
3) The document recommends countries invest in voluntary, evidence-based drug treatment in communities and cease practices that increase HIV risks and violate human rights.
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This document discusses frameworks and approaches for preventing chronic conditions. It covers the stages of prevention, population and life-course approaches, evidence for prevention strategies, and global and national initiatives. Key points include: (1) prevention aims to reduce disease risk and progression, (2) early intervention is most effective across the lifespan, and (3) strategies target risk factors like tobacco, alcohol, nutrition and physical activity at multiple levels.
The document discusses Continua Health Alliance, an organization working to advance remote patient monitoring through open interoperability standards. It aims to address the growing costs of chronic diseases by enabling up to 60% of medications to be taken correctly through remote monitoring solutions. Continua brings the healthcare and technology industries together to develop guidelines and certify products, helping create an ecosystem to support the expanding connected health market, estimated to grow to $7.7 billion by 2012.
This document discusses the prevalence of Alzheimer's disease and other dementias among older Medicare beneficiaries. It finds that in 2009, 13% of those dually eligible for Medicare and Medicaid and aged 65 or older had been diagnosed with dementia, compared to only 4% of Medicare-only beneficiaries. The prevalence increases sharply with age, with 31% of dual eligibles aged 85 or older having a diagnosis. Due to the high costs of care and increased likelihood of impoverishment, integrated care programs need to account for the needs of those with dementia.
Minimally disruptive medicine aims to reduce the burden of treatment on patients pursuing chronic disease management while still achieving treatment goals. The cumulative complexity model shows how workload, capacity, and context affect a patient's treatment burden over time. A key problem is that evidence-based guidelines often do not consider comorbidities or the patient's perspective on priorities. Minimally disruptive care coordinates treatment, simplifies regimens when possible, and individualizes care based on the patient's needs and preferences. The overall goal is for patients to feel better and live longer without undue complications from the healthcare system itself.
Pharmacovigilance and Drug-Drug Interactions: Ensuring Patient SafetyClinosolIndia
Pharmacovigilance plays a crucial role in identifying and managing drug-drug interactions (DDIs) to ensure patient safety. Drug-drug interactions occur when two or more medications interact in a way that alters their effects, potentially leading to unexpected adverse events or reduced therapeutic efficacy. Proper pharmacovigilance practices help mitigate the risks associated with DDIs and promote safe medication use. Here's how pharmacovigilance contributes to ensuring patient safety in the context of drug-drug interactions:
The document discusses the design of a proposed "Troops to Nurses" program using Schlossberg's model of transition. [1] The program would help transition military veterans with healthcare experience or degrees into nursing careers to address the nursing shortage. [2] Schlossberg's model focuses on the four S's - situation, self, support, and strategies - and has been applied to similar transition programs. [3] The document outlines how the model applies to the target population and program design.
Jonathan Weiner: Risk adjustment opportunities and challenges: US and UK expe...Nuffield Trust
The document summarizes a presentation given by Professor Jonathan Weiner on risk adjustment opportunities and challenges in the US and UK. It discusses the conceptual domains of risk adjustment, case-mix, and predictive modeling. It also describes experiences using the Johns Hopkins ACG risk adjustment method in the US and UK for budgeting, financing, and beyond. Finally, it addresses some issues, opportunities, and challenges with risk adjustment in the English primary care context.
go to www.medicaldump.com to download this file and check out other medical powerpoints, medical powerpoint templates, medical pdfs and all other medical documents.
This document provides guidance on reviewing polypharmacy, which is the use of multiple medications. It is important to review polypharmacy because many elderly patients are on multiple drugs but around half may not be taken as prescribed and adverse drug reactions are common, especially with more comorbidities rather than age. The guidance aims to help practitioners review medications and potentially deprescribe those where risks outweigh benefits by providing tools and considerations. Key points are identifying high-risk patients for review, focusing on certain drug classes, and balancing multiple treatment guidelines for individual patient circumstances through comprehensive medication reviews.
The document summarizes a presentation about how nonprofits can generate revenue through social enterprises. It discusses identifying organizational assets that could be leveraged, turning those assets into business opportunities, screening opportunities, conducting feasibility assessments, creating business plans, and implementing successful social enterprises. Examples of social enterprises launched by nonprofits in North Texas are provided. The presentation encourages nonprofits to consider social enterprise as a way to diversify funding and generate sustainable revenue to support their missions.
The document discusses the SOAR framework as an alternative to SWOT for strategic planning. It summarizes SOAR as focusing on strengths, opportunities, aspirations, and results with a collaborative rather than competitive mindset. The presentation then guides attendees through a SOAR exercise to identify their organization's strengths, opportunities, aspirations, and results and how to build on them.
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This document summarizes a presentation on engaging physicians in prevention efforts to address the opioid epidemic. It was presented by Yngvild Olsen and included the following key points:
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Substance abuse treatment is tailored to help with recovery from drug and alcohol addiction. Comprehensive services are the key to success. Learn more about substance abuse treatment at FindRehabCenters.org and get help finding the appropriate treatment center for you. (877) 322-2450
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Gastrointestinal Infections
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The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
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Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
Screening and brief intervention partnering with primary care field
1. 2/1/2012
Craig Field, PhD, MPH
Associate Professor Program Director
Screening & Brief Intervention
Health Behavior Research
& Training Institute Trauma Department
UT Austin University Medical Center at
Brackenridge
craig.field@austin.utexas.edu
2
Source: JAMA, 2004.
Source: CASA Columbia University, 1994. 3
1
2. 2/1/2012
Source: Closing the Addiction Treatment Gap, 2010. 4
Substance use services have been focused in two areas:
Primary Prevention – Delaying onset of substance use.
Tertiary Prevention (Treatment) – Providing time, cost,
and labor intensive services to patients who are acutely
or chronically ill.
5
Substance Dependent
No Problem
6
2
5. 2/1/2012
We could provide a 100% cure to every substance
dependent person in the United States we wouldn’t be
close to curing most of the substance related problems
in our country.
13
4% Dependent
25% Heavy Drinkers
71% Low or No Risk
14
The health care system routinely screens for potential
medical problems (cancer, diabetes, hypertension),
provides preventative services prior to the onset of
acute symptoms, and delays or precludes the
development of chronic conditions.
15
5
6. 2/1/2012
Substance Use Is
A Public Health Problem 16
# Service Preventable Cost
Burden Effectiveness
1 Aspirin: Men 40+ Women 50+ 5 5
2 Childhood Immunizations 5 5
3 Smoking Cessation 5 5
4 Screening & Brief Intervention 4 5
5 Colorectal Cancer Screening 4 4
6 Hypertension Screening and 5 3
Treatment
Source: Am J Prev Med 2006; 31 (1) 52-61 17
6
7. 2/1/2012
Maximum Daily Limits Maximum Weekly
Limits
Women 3 7
Men 4 14
Men >65 3 7
Less is Better!
Source: NIAAA, 2009 19
Our prime directive should no longer be limited to
identifying people who are dependent and need higher
levels of care.
Our prime directive should also be to identify those
who are at moderate or high risk for psycho‐social or
health care problems related to their substance use
choices.
20
SBIRT uses a public health approach to universal
screening for substance use problems.
SBIRT provides:
Immediate rule out of non‐problem users;
Identification of levels of risk;
Identification of patients who would benefit from brief
intervention, and;
Identification of patients who would benefit from higher
levels of care.
21
7
8. 2/1/2012
Brief
Brief Out‐ Hospital‐
Screening Interven‐ ization Inpatient
Therapy patient
tion
22
Stepped‐Care Model
Try to intervene with the least complicated and/or
least costly intervention.
Proceed to the next level of intervention only if the
student fails to respond to the first.
Requires follow‐up to determine if the intervention
was effective.
SBIRT is a primary, secondary,
and tertiary prevention and
treatment strategy designed to
intervene based on patient need
and prevent/treat substance use
problems at various levels.
24
8
9. 2/1/2012
Pre‐screening (universal).
Full screening (for those with a positive pre‐
screen).
Brief Intervention (for those scoring over the cut
off point).
25
Brief Treatment (for those who have moderate risk,
high risk, abuse, or dependence, would benefit from
ongoing, targeted interventions, and are willing to
engage).
Traditional Treatment (for those who are dependent
and are willing to engage).
26
Universal Brief Screen
Positive Reinforcement
Negative
Low Risk:
Positive Positive Reinforcement
Moderate Risk:
Brief Intervention
Further
Moderate – High Risk:
Screening Referral to Brief Therapy
High Risk:
Referral to Treatment
27
9
10. 2/1/2012
Severity of Alcohol Problems
Dependent drinking/Alcoholism SBIRT
Harmful drinking/Abuse SBI
Risky/Hazardous drinking
Safe drinking
Screen
Abstinent
SBIRT is an evidenced based practice that is supported
by:
Center for Substance Abuse Treatment
The World Health Organization
The American Preventative Task Force
The American Trauma Nurses Association
The American Medical Association
The American College of Surgeons
The Office of National Drug Control Policy
29
DUI
Injury
Violence
Pregnancy
STD
Substance Dependence
Health Care Problems
30
10
11. 2/1/2012
New Referral Streams
Evidence‐based Practices
Improved Outcomes
Enhanced Relationships with Health Care
More Inclusive Continuum of Care
Broader Patient Base
Alternate Funding Streams
Larger Role and Increased Credibility
31
• Healthcare reform provides an
opportunity for SBIRT
• Emphasis on preventive care and wellness
• Integration of primary and behavioral
health
• SBI as essential health benefit
32
Screening is a broad term defined as a range of
evaluation procedures and techniques. A screening
instrument does not result in a clinical diagnosis, but
indicates the probability that the condition looked for is
present.
A brief intervention is a short (10‐15 min) conversation
based on motivational interviewing that ends on good
terms and improves chances that the person that is
involved in risky alcohol consumption will alter their
behavior to reduce risk.
11
12. 2/1/2012
Dunn C. et al. Hazardous drinking by trauma patients during the year after injury. J Trauma. 2003;54:707–712.
12
13. 2/1/2012
Precontemplation = Never
Contemplation = Maybe
Preparation = Soon
Action = Now
Dunn C. et al. Hazardous drinking by trauma patients during the year after injury. J Trauma. 2003;54:707–712.
13
15. 2/1/2012
The absolute risk reduction implies that only nine patients
would need to receive a BI to prevent one DUI arrest.
Level I & II Trauma Hospitals
“The trauma center does not have a mechanism to identify
patients who are problem drinkers:
Level I Trauma Hospitals
“ The trauma center does not have the capability to provide
intervention or referral for patients identified as problem
drinkers”
‐ COT Resources for Optimal Care of the Injured Patient 2006‐
15
17. 2/1/2012
• Getting buy‐in at all levels
• Administrators
• Clinical
• Business
• Cost savings
• Reimbursement is available
• The Joint Commission
• The American College of Surgeons
• Committee on Trauma
• SBIRT purpose and effectiveness
• Evidence base
The World Health Organization
The American Preventative Task Force
The Emergency Nurses Association
The American Medical Association
The American College of Surgeons/COT
• Patient stories
17
18. 2/1/2012
• Cost savings were $89 for each patient
screened and $330 for each patient provided
with a BI
• Reduced health expenditures were $3.81 for
every $1.00 spent on SBI
• If SBI was routinely offered to eligible injured
adult patients the potential net savings would
exceed $1.5 billion annually.
Source: Gentilello, Eble, Wickizer, et al., (2005). Alcohol Interventions for trauma patients treated in
emergency departments and hospitals: A cost benefit analysis. Annals of Surgery, 241(4):541‐550.
• Needs assessment
• Inform, educate and train staff
• Define your target population
• Develop clear protocols
• Establish relationships
• Develop a charting protocol
• Develop a billing strategy
• Develop a data collection and storage plan
• Develop quality improvement initiatives
• Establish referral network
Conduct a facility needs assessment that
considers patient demographics, patient
flow, time requirements, internal and
external policy, staffing resources, fiscal
resources, space, IRB requirements, and
technology.
54
18
19. 2/1/2012
• Top down and bottom up support
• Internal champion
• Internal and external policy
• Current screening protocols
• Training needs
• Space
• Patient flow
• Patient demographics
• Technology
• Hospital Administration
• Chief of Trauma Surgery
• Trauma Nurse Coordinator
• ER Nurse Manager
• Behavioral Health Staff
• Business office staff
• Medical Records
• Legal department (HIPAA/42 CFR, Part 2).
56
• Who is the population to be served?
• Who will provide the service?
• What tools will they use?
• When/where will the service be
provided?
• How will records be kept?
• How will the services be billed?
19
20. 2/1/2012
Who, how many, when, and where you screen will affect
the time requirements for interventions.
Typical patient service sequences and lengths of stay will
influence when interventions can be performed.
The type and length of intervention you choose will affect
time availability.
How you will cover different shifts (if necessary) will affect
how many interventionists you need.
Whether you have intervention personnel also perform
screening or have others do screening will affect time
required.
58
• Which patients will you screen?
• Universal vs. targeted
• Dependent users/Risky users
• Adults/Adolescents (consent)
• Which patients will you exclude from
screening?
• What substances will you screen for
• Will you screen for mental health
• Who will conduct pre‐screen/screen
• When and where will screening be conducted
• How will results be documented
• How will results be communicated
20
21. 2/1/2012
• Who will conduct the brief intervention
• Which BI support materials will be used
• Which patient handouts will be used
• When and where will brief intervention be conducted
• How will goals be documented
• How will goal be communicated
• Knowledge and experience
• Interpersonal skills
• Willingness to take on responsibility
• Flexibility in work schedule
• Where will chart note be kept
• Main medical record
• Locked files
• Separate from the medical record
• What information will be included
related to the screen and/or brief
intervention
• Determine the flow of information,
paperwork, and data
21
22. 2/1/2012
Payer Code Description Fee
Commercial CPT 99408 Alcohol and/or substance abuse structured $33.41
screening and brief intervention services;
15 to 30 minutes
Alcohol and/or substance abuse structured
CPT 99409 screening and brief intervention services;
greater than 30 minutes
$65.51
Medicare G0396 Alcohol and/or substance abuse structured $29.42
screening and brief intervention services;
15 to 30 minutes
Alcohol and/or substance abuse structured
G0397 screening and brief intervention services;
greater than 30 minutes $57.69
Medicaid H0049 Alcohol and/or drug screening $24.00
Alcohol and/or drug service, brief intervention,
H0050 per 15 minutes $48.00
64
• CMS authorized two new HCPCS codes to reimburse
for SBI.
• States may choose not to activate these codes.
• CMS has authorized the use of two new G codes to
reimburse for SBI.
• These codes can be billed beginning January 08.
• The AMA has authorized the use of two new CPT
codes to reimburse for SBI.
• Insurance carriers may choose not to reimburse these codes.
65
• Who will monitor and report SBI productivity
• Who is collecting your trauma data
• What will be reported and to whom
• % of all patients eligible to be screened
• % of all eligible for screening actually screened
• % of all those screened who screened positive
• % of all those positive screens who received a BI
66
22
23. 2/1/2012
• What data do you collect
• How do you collect data
• Can you incorporate your SBI data into the
Trauma Registry
• How do you ensure data security
67
Screening, Brief Intervention & Referral
for Treatment for Trauma Patients
Trauma Patients Meeting Criteria : 187
September 16 – October 15, 2011
Self
Report/BAC/UDS
Brief Interventions Provided
Outcomes: Discharge Prior,
16
Discharge
Negative Interventions Prior, 12
108 44
Positive
Unable to
63 Participate, 6
Decline, 1
Summary: Admission Order Set: UDS Collected
• Patients screened 91.4% • Trauma 74.8%
• Patients had UDS drawn 55.1% • Hospitalist 48.7%
• Patients had BAC drawn 64.0% • Surgery 8.3%
• Brief Interventions provided 77.2%
Screening, Brief Intervention & Referral
for Treatment for Trauma Patients
Trauma Patients Meeting Criteria : 1825
December 15, 2010 – December 15, 2011
Self Brief Interventions Provided
Report/BAC/UDS Discharge prior, 119
Outcomes:
Negative, 941 Discharge
Interventions, prior, 89
Interventions,
38
533
Positive,
Positive, 765 Unable to
67 participate
, 92
Shift, 42
Decline, 9
Summary:
• Patients screened 93.2 %
• Total Urine Drug Screen 52.0 %
• Total BAC drawn 63.2%
• Brief Interventions provided 84.5%
23
24. 2/1/2012
Extrapolating from data presented in peer reviewed
publications, program activities last year are estimated to have
prevented 59 arrests for driving while intoxicated following
discharge and 26 readmissions for treatment of a traumatic
injury. Given that the average cost of admission for a traumatic
injury in a Level 1 Trauma Center is $14,567, $378,742 in
healthcare cost will be avoided in the next three years as the
result of reductions in rates of injury recidivism. Given that
the net cost savings of the intervention has been estimated at
$89 per patient screened or $330 for each patient offered an
intervention, total healthcare cost savings from the program
are conservatively estimated at nearly $250,000. In summary,
screening and brief intervention for at risk drinking fills a gap
in current services, the program has positively impacted the
lives of patients and the surrounding community at no, or
minimal costs to the organization.
• What are your outcome measures
• What are your training requirements
• How do you monitor fidelity
71
24
27. 2/1/2012
Health Behavior Change a Guide for Practitioners
Rollnick, Mason & Butler
Motivational Interveiewing in Health Care: Help
Patients Change Behavior
Arkowitz, Westra, Miller & Rollnick
1. One thing you liked.
2. One thing you liked less, thought was missing and/or
would’ve like to heard more about.
27