The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility

Abstract

Background: Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model.

Methods: Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1-3. (5) Modified Patient Choice: choice of models 1-2, Electronic Referral offered if 1-2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates.

Results: Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ(2) (4, N=50)=34.8, p<0.001.

Conclusions: The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable.

Keywords: Brief motivational intervention; Referrals; Screening; Substance abuse; Technology; Telehealth.

Conflict of interest statement

Conflict of Interest

Edwin D. Boudreaux, PhD - is an employee of the University of Massachusetts Medical Center and receives consulting income and licensing revenue from Polaris Health Directions.

Tina Harralson, PhD - is an employee of Polaris Health Directions. Polaris Health Directions, Inc, intends to market RBIRT for financial gain. An intellectual property and licensing agreement exists between the University of Massachusetts Medical School and Polaris Health Directions.

Brianna Haskins, MS - Conflict of interest: none.

Edward Bernstein, MD Conflict of interest: none.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1. R-BIRT Overview

1,3Images available via public domain2 Image courtesy of ©iStock.com/Squarespixels https://creativecommons.org/licenses/by/2.0/

Figure 2. Patient Satisfaction with the R-BIRT Consultation (n=27)

Note: Patient satisfaction rating for each item are depicted as percentages within each response category. Only those patients who completed a consultation during the ED visit were available to complete the satisfaction assessment (n=27).