SBIRT in Primary Care Practice

 

Get free four hours of CME, potentially ward off a KBML review, and save lives for only a fraction of your time. The Kentucky Cabinet for Developmental Behavior has tasked Family Physicians in the following counties to increase their knowledge of screening, brief intervention, and referral to treatment (SBIRT) with 4 CME hours at NO COST in order to save lives! Research shows that more people die every year from opioid/multidrug overdose rather than motor vehicle accidents. Substance abuse results in over 100,000 deaths annually and costs the public over $600 billion. Those numbers can be significantly reduced by taking a simple 4-hour online SBIRT course. If you are an Opioid prescriber, taking this course will help you identify patients who are at risk for addiction, so they can choose more appropriate medications as treatment, prevent adverse consequences that might lead to complaints from patients &/or community members about controlled substance prescribing.

To combat the escalating opioid epidemic that is infecting not only our Commonwealth but our nation, it is imperative that we, as family physicians, utilize our role as the “hub” of medicine to stand at the forefront of this integrated and comprehensive public health approach. Taking the SBIRT course and implementing it within our practice will allow us to do what we do best; we can increase prevention and intervention. With over 1.5 million patients screened since 2003, SBIRT is working. It has been shown to reduce short and long-term health care costs. Late-stage intervention and treatment is expensive and becomes more expensive when a patient’s long-term abuse leads to comorbid health conditions. SBIRT is reimbursed by private insurance, Medicaid, and Medicare, and appropriate billing codes along with other information are available in the references below.

Family physicians, and other primary care providers, are ideally suited to help address the opioid epidemic and other substance use disorders with the help of SBIRT training. We manage complicated chronic diseases daily, and we provide care for our patients throughout their lives. Many chronic diseases, including COPD, liver disease, and cancer, result from substance use disorders. People with opioid use disorder are at risk of developing hepatitis C and HIV, which can also be treated in a primary care environment or when necessary referred for specialty care. As family physicians who are well trained in providing comprehensive care for patients at all ages, we must take an active role in addressing the opioid epidemic and improve our skills at identifying substance use disorders in our patients. Addressing this devastating epidemic with SBIRT will improve the health of our patients and will build trust within the communities within which we provide care.

Although substance abuse intervention and treatment methods have been utilized in the past, they have primarily focused on universal prevention strategies and directed specialized treatment to those identified as current high abuse victims. SBIRT, however, addresses the gap these prior service systems overlooked: at-risk populations.  SBIRT is an evidence-based tool that allows for physicians or other staff members within a practice to screen patients for substance abuse, conduct brief interventions, or ongoing care within our primary care offices and, when necessary, refer patients who need specialized treatment to our behavioral health colleagues.

  • The first step is Screening. There are two levels of screening tests that can be seamlessly incorporated into most primary care visits. Practices can provide the questionnaire to the patient in the waiting room or exam room or an MA, nurse, or other provider can administer the questionnaire. Patients undergo the initial brief screening used to identify substance use frequency and quantity. Patients identified with hazardous use obtain further screening including DAST-10, AUDIT-10, ASSIST, and CRAFFT as well as benefit from brief counseling with motivational interviewing from their primary care physician.
  • The second step is brief intervention. When substance abuse is identified, counseling and brief intervention is administered with the following steps: Raise the subject, provide feedback, enhance motivation, and negotiate a plan to change.
  • Next is brief therapy. For patients with substance dependence, especially opioid dependence, which is life threatening, brief counseling is combined with ongoing follow up and re-evaluation. This step includes motivational discussion focused on self-efficacy and goal setting, assessment, education, problem-solving, coping strategies, and finding the right support system. This step typically lasts for a duration of four to six sessions.
  • The final step is referral to treatment. This is if deemed necessary by the attending physician due to a patient’s high risk. Here, the facilitation to access specialty care begins and treatment with lifesaving medications should be offered. Ideally, more family physicians will become certified to prescribe buprenorphine/naloxone to treat opioid use disorder in the primary care setting. If MAT with buprenorphine/naloxone is not available in the primary care setting or methadone is the preferred treatment, the provider should provide a prescription for naloxone and refer the patient immediately for MAT combined with psychosocial intervention.

 

Let’s get started. The SBIRT course is a simple process that leads to big results. To access the course, follow the steps below:  

  1. Go to http://www.kafp.org/sbirt-training/ and register to attend the live CME event or to take the course online.
  2. Once you register with the KAFP, you will be emailed a coupon code to receive this course for FREE.
  3. Navigate to SBIRTTraining.com website and use the green Access Training to see the training program options.
  4. Choose the SBIRT Core Training program
  5. First time users will Create Account with the Grey button, returning users Login with the green button. You can always login with their email address if they forget their username.
  6. On the Create Account Page you will need to enter the name/password and other requested data, then use the green Create New Account
  7. After this step, you will go to the Activity Home Page. A series of green buttons at the top of the screen will

walk the user through the Activity Description, pre-survey and pre-test

  1. After the Activity Description, you will need to “Purchase” the program. You can “pay” by entering the coupon code in the Coupon Code box which will reduce the cost to $0. This page requires address information since we need to be sure we collect it, but there will be no charge to the user. No credit card info is requested. Use the green buttons to SUBMIT and then after that Start the Activity
  2. You will tell us a bit about their demographics so we can give aggregate information to NIH who funded the development, then there is a pre-survey and a pre-test. These are all found via the green button at the top of the Activity Home Page
  3. You can work through the modules by clicking on the title boxes in any order.
  4. When they are done, green buttons at the top lead to a post-test, a post-survey, and a credit certificate request form.
  5. Questions can be sent to us using the green NEED HELP? CONTACT US link in the top right corner.

 

Sources

http://www.aafp.org/afp/2013/0715/p113.html

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf

Billing Codes

https://www.cms.gov/Outreach-and-Education/Medicare-Learning NetworkMLN/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf

http://my.ireta.org/sbirt-reimbursement-map

https://www.samhsa.gov/sbirt