Sandeep Kapoor, MD Director, SBIRT Assistant Professor of Medicine Hofstra North Shore-LIJ School of...
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Transcript of Sandeep Kapoor, MD Director, SBIRT Assistant Professor of Medicine Hofstra North Shore-LIJ School of...
Sandeep Kapoor, MDDirector, SBIRT
Assistant Professor of MedicineHofstra North Shore-LIJ School of Medicine
SBIRT at NSLIJNew York Screening, Brief Intervention, and Referral to Treatment
(NYSBIRT-II)
North Shore-Long Island Jewish Health SystemDepartment of Emergency Medicine Division of General Internal Medicine
Department of Psychiatry & Behavioral Health
Dr. Kapoor have no conflicts of interest to report.
Sponsored by the NYS Council for Community Behavioral
Healthcareand the
National Council for Behavioral Health
NYSBIRT-II
Collaborative TeamDepartment of Emergency Medicine Division of General Internal Medicine
Department of Psychiatry & Behavioral Health
SAMHSA (Substance Abuse and Mental Health
Services Administration)Service Grant Sponsor
OASAS (NYS Office of Alcoholism and Substance
Abuse Services)Service Grant Administrator
CASAColumbia and NSLIJService Grant Partners
Training, Technical Assistance, Grant Evaluators - CASAOperations and Clinical Services - NSLIJ
Internal Medicine 865 Northern Blvd
LIJ – ACU2001 Marcus Ave
Staten Island North - MAP
Emergency Medicine Southside ED
SIUH - South EDSIUH - North ED
Lenox Health Greenwich Village
NSLIJ SBIRT Sandeep Kapoor, MD Director, NSLIJ SBIRT Nancy Kwon, MD, MPA Principal Investigator – Emergency Medicine
Joseph Conigliaro, MD, MPH Principal Investigator – Internal Medicine
Jon Morgenstern, PhD Principal Investigator – Psychiatry
NSLIJ Department of Medicine Thomas McGinn, MD, MPH Chairman, Medicine
Jeanne Morley, MD SBIRT MD Champion – Internal Medicine
Lauren McCullagh, MPH Administrative Director - Research
NSLIJ Department of Emergency Medicine John D’Angelo, MD Chairman, Emergency Medicine
Mark Auerbach, MD, MBA SBIRT MD Champion
Mae Ward, RN Administrative Director – Research
Karen Kline Senior Administrative Director II
NSLIJ Department of Psychiatry John Kane, MD Chairman, Psychiatry
Bruce Goldman, LCSW The Zucker Hillside Hospital
Daniel Coletti, PhD The Zucker Hillside Hospital
The National Center for Addiction and Substance Abuse at Columbia University (CASAColumbia)
Charlie Neighbors, PhDDirector
Megan O’Grady, PhD Associate Director
New York State Office of Alcoholism and Substance Abuse Services (OASAS)
Connie Burke NYSBIRT Project Director
Peggy Bonneau Director of Health Initiatives
Leadership
Completed PreScreens
PreScreen Positive
Brief Interventions
Referralsto Treatment
Southside ED (20 months) 23,490 14% 1143 295
SIUH South ED (15 months) 8,850 10% 417 68
SIUH North ED (15 months) 18,650 9% 573 87
Lenox Health GV (12 months) 5,264 24% 512 166
Services Delivered*During SBIRT Health Coach Hours*
Dec2013-July2015
Primary Care + Emergency Medicine (20 months)
104,357 11% 3708 729
Who?What?
Where?When?Why?
Understanding the Importance
How many people are at risk?
• More than 1/2 of Americans age 12+ years are current drinkers– An estimated 58.6 million people (23.1% of general population) recently
engaged in a heavy drinking episode– 16.9 million reported a heavy drinking episodes on ≥ 5 days in the past
month – An estimated 18.7 million Americans drink alcohol in ways that are
potentially unhealthy
• 20.5 Million people need, but do not receive treatment for illicit drug or alcohol use
• Major source of referrals to treatment are NOT healthcare providers (only 6.6%), though most people see a doctor at least one time per year
Reference: SAMHSA (2011). 2010 National Survey on Drug Use and Health
Survey on Patient Attitudes
Agree/Strongly Agree
“If my doctor asked me how much I drink, I would give an honest answer.”
92%
“If my drinking is affecting my health, my doctor should advise me to cut down on alcohol.”
96%
“As part of my medical care, my doctor should feel free to ask me how much alcohol I drink.”
93%
Disagree/Strongly Disagree
“I would be annoyed if my doctor asked me how much alcohol I drink.”
86%
“I would be embarrassed if my doctor asked me how much alcohol I drink.”
78%
Patients Are Open To Discussing Their Substance Use
Source: Miller, P. M., et al. (2006). Alcohol & Alcoholism.Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum
(www.sbirtoregon.org)
Who?What?
Where?When?Why?
Understanding the Importance
The SBIRT Process
SBIRT Components
Pre-ScreeningBrief strategy to identify at-risk population using a valid, brief standardized questionnaire at the initial point of service
< 1 minute
Full ScreeningValid extended standardized questionnaire administered with patient if they qualify based on the prescreen scores
< 3 minutes
Brief Intervention
One or more discussions with health care professional focused on reducing or stopping unhealthy substance use:
1. Assessment & feedback on substance use2. Simple advice, goal setting, agree on plan
10-20 minutes
Referral to Specialty Treatment
Based on extent of substance use/abuse, patients may require more than a brief intervention
Every effort is made, in real-time, to provide a ‘warm handoff’ to community treatment providers and those within the NSLIJ Health System.
Pre-Screening Questions: Alcohol, Drugs, Tobacco
1. How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week
2. How many standard drinks containing alcohol do you have on a typical (drinking) day?
1 or 2 3 or 4 5 or 6 7 to 9 10 or more
3. How often do you have 6 or more drinks on one occasion?
Never Less than monthly Monthly Weekly Daily or almost daily
4. In the past 12 months have you used drugs other than those required for medical reasons?
Yes No
5. In the past year, how often have you used tobacco products? Never Once or twice Monthly Weekly Daily or almost daily
Who?What?
Where?When?Why?
By January 2015, eight sites (in Long Island, Staten Island, and Manhattan) will provide SBIRT services.
As there are 18 Hospitals and nearly 400 points of entry within NSLIJHS, SBIRT service implementation
system wide will speak volumes.
Emergency Department
Internal Medicine Clinic
NSLIJ Sites for SBIRT Services
Patient enters the Emergency
Room
Patient is pre-screened by RNs after vital signs
Responses from pre-screen are documented
into EMR *Positive screen will elicit
an ICON to the Health Coach.
Health Coach will perform full screen and provide brief intervention for
positive full screens
Health Coach will discuss case with
treating Physician/Nurse
Health coach will work with clinical
team members and PATIENT to secure a
referral to treatment if needed
ED SBIRT Workflow
Who?What?
Where?When?Why?
Understanding the Importance
Making the Connection
Similar to preventative screenings for chronic diseases (ie. diabetes and hypertension)
Risky use
SBIRT allows us to NORMALIZE the discussionand treat substance use as the healthcare issue it is
Heart DiseaseHypertension
GastritisSleep
DepressionCancers
STDs Fetal alcohol spectrum
disorders
Substance Use Continuum
Rethinking Substance Use Problems From a Public Health Perspective
Programmatic
Service Delivery
“The road to success is
paved by challenges”
Referral To Treatment
Let your passion motivate others…
Allow their passion to motivate sustainability…
TrainingImplementationService DeliveryYear One Completed
What’s Next?
Refresh/Revisit all TrainingElicit Feedback on ImplementationExamine Fidelity of Service Delivery
What’s Next?
Engage… Engage… ENGAGEAllow their passion to motivate sustainability…