Table 1 Key Features of Included Studies
Article | Framework | Design and Timeline | Location | Setting | Population | Substance Type | Who is providing SBIRT | Sample | Outcomes |
|---|---|---|---|---|---|---|---|---|---|
Anderson et al., 2016 [43] | None | Cluster randomized 2x2x2 factorial trial 4 weeks (baseline) 12 weeks (implementation) | Catalonia, England, the Netherlands, Poland, Sweden | 120 primary healthcare centers | Adults | Alcohol | Providers (general practitioners, nurses, or other professionals) | Approximately 5000–20,000 registered patients at the healthcare centers Average of 1500 consultations at each center per month | Screening significantly increased in groups that received training/support (Groups 2, 5, 6, 8) compared to groups that did not. Screening significantly increased in groups who received financial reimbursement (Groups 3,5,7, 8) compared to groups that did not. Not a significant increase in screening for the groups that received the electronic brief intervention (Groups 4, 6, 7, 8) compared to groups that did not. |
Bendsten et al., 2016 [45] | None | Subanalysis of a randomized controlled trial (Anderson et al., 2016) 4 weeks (baseline) 12 weeks (implementation) | Catalonia, England, the Netherlands, Poland, Sweden | 120 primary healthcare centers | Adults | Alcohol | Providers (general practitioners, nurses, or other professionals) | Approximately 5000–20,000 registered patients at the healthcare centers Average of 1500 consultations at each center per month | Not a significant increase in screening for the groups that received the electronic brief intervention (Groups 4, 6, 7, 8) compared to groups that did not. Significant increase in proportion of patients who received brief advice in the sample as a whole (70 to 80%, p < 0.05). |
Bernstein et al., 2007 [51] | None | Pre-post- repeated measures design 12 months | United States | 14 academic emergency departments | Emergency department patients | Alcohol | Providers (physicians, registered nurses, advanced practice providers, social workers, and other staff) | 288 providers | Significantly higher utilization of SBIRT skills 3 months (p < 0.001) and 12 months (p < 0.001) after receiving education, when compared to baseline. Providers reported higher utilization of SBIRT skills at 3 months than 12 months. |
Egizio et al., 2019 [50] | None | Pre-posta 30 days | United States | Field placement of supervisors (e.g., family service agencies, hospitals, community clinics, housing programs) | All patients coming in contact with field supervisors | Alcohol and other drugs | Social workers who provided field supervision to social work students delivering SBIRT | 74 field supervisors | Increase in the percentage of supervisors who used motivational interviewing (73.9 to 86.5%) and SBIRT (17.4 to 43.2%) when comparing baseline to 30 days after training. |
Henihan et al., 2016 [44] | Framework for Design and Evaluation of Complex Interventions to Improve Health | Randomized controlled pre-and-post design 3 months | Ireland | 15 primary care facilities | Adults receiving addiction treatment with an opioid agonist | Alcohol | General practitioners | 81 patients (34 in the intervention group and 47 in the control group) | A higher percentage of patients in the intervention group were screened (53% versus 26%), received a brief intervention (47% versus 19%) and received a referral to treatment (3% versus 0%) when compared to the control group. |
Lapham et al., 2012 [49] | None | Retrospective, natural history study 12 months (baseline) 3 months (transition) 3 months (implementation) 9 months (dissemination) | United States | Outpatient Veteran Affairs facilities | Veterans | Alcohol | Providers | 6788 patients who screened positive for alcohol misuse | The percentage of patients receiving a brief intervention increased significantly over time from 5.5 to 29% (p < 0.001). |
Lindholm et al., 2010 [34] | None | Pre-posta 12 months (pre-intervention) 12 months (post-intervention) | United States | 18 primary care clinics | Adults | Tobacco | Medical assistant completed screening, clinicians provided brief intervention | 502,359 patients (255,138 pre-intervention and 247,221 post-intervention) | Statistically significant increase in documentation of smoking status from 71.6 to 78.4% (p < 0.001). Pre-intervention data not available for brief intervention or referral to treatmen.t |
Mello et al., 2009 [42] | None | Quality improvementa 1 month (baseline) 6 months (Phase 1) 6 months (Phase 2) | United States | 1 community hospital emergency department | Not a specific population | Alcohol | Physicians, physician assistants, and nurse practitioners provided the screening and referral. Research assistants provided the brief intervention | 1509 patients (254 baseline, 922 when research assistant was in the emergency department during the study, 333 patients one month after the research assistant was no longer present) | Screening by emergency department staff increased from 50% (baseline) to 71% (when research assistant was present), then back to 50% after research assistant was no longer present. |
Mello et al., 2013 [35] | None | Longitudinala 12 months (adoption) 12 months (implementation) 12 months (maintenance) | United States | 7 pediatric trauma centers | Admitted adolescent trauma patients | Alcohol | Differed at each site, but in general, nurses completed screening and social workers provided brief intervention and decided on referral to treatment | 400 patients (160 baseline, 116 in implementation phase, 124 in maintenance phase) | The percentage of patients screened increased from 11% (baseline) to 73% (implementation and maintenance phases). |
Mertens et al., 2015 [46] | None | Cluster randomized implementation trial 12 months | United States | 54 primary care clinics | Adults | Alcohol | Arm 1: Physicians Arm 2: Non-physician providers (i.e., clinical health educators, behavioral medicine specialists, nurses) and medical assistants Arm 3: Usual care | Average number of visits per month= 35,519 patients in Arm 1, 34,167 patients in Arm 2, 31,935 patients in Arm 3 | Screening was highest in Arm 2 (51%) compared to Arm 1 (9%) and Arm 3 (3.5%). For patients screening positive, the brief intervention and referral was highest in Arm 1 (44%) compared to Arm 2 (3.4%) and Arm 3 (2.7%). |
Muench et al., 2015 [36] | None | Longitudinala 2 years | United States | 6 primary care clinics | Adults | Alcohol and other drugs | Receptionists gave annual screen to patients at check-in Medical assistants scored the screen, and if indicated, completed a more detailed brief assessment Clinicians (physician, physician’s assistant, nurse practitioner) performed the brief intervention | Approximately 11,000 patients each quarter | Screening rates significantly increased over time, with a median increase of 6.4% between quarters (p < 0.05). Brief assessment rates (AUDIT and/or DAST) increased over time, with a median increase of 7.0% between quarters (p < 0.05). Brief intervention rates decreased over time, with a decrease of 3.7% between quarters. A non-significant trend (p > 0.05). |
Rieckmann et al., 2018 [37] | Consolidated Framework of Implementation Research | Longitudinal mixed- methods design 30 months (pre-implementation) 6 months (transition period) 30 months (post-implementation) | United States | Primary care | 18–64 year old Medicaid recipients enrolled in a coordinated care organization | Alcohol and other drugs | Unknown | 516,708 members in the study population | Quantitative analysis revealed a significant increase in SBI rates from 0.1% of patients (baseline) to 4.6% of patients (last six months of study). Qualitative analysis revealed the importance of aligning incentives, workflow redesign, and leadership facilitation. |
Salvalaggio et al., 2015 [47] | Knowledge Translation | Non-randomized, pre-post, quasi-experimental intervention design 6 months (patient-level implementation) 6 months (provider access to knowledge translation resources) | Canada | 3 primary care networks, 3 emergency departments, 3 residency programs | Patients who received care in socio-economically disadvantaged neighborhoods | Alcohol and other drugs | Physicians/residents | 64 physicians/residents (39 in the intervention group and 25 in the control group) | Overall, physicians reported that they were more likely to screen (p = 0.008) and refer for treatment (p = 0.017) after 12 months. Exposure to the intervention predicted brief intervention behavior (p < 0.05) but not screening or referral behavior. |
Sharifi et al., 2014 [41] | None | Pre-post study 3 months (pre-intervention) 1 month (intervention) 3 months (post-intervention) | United States | 1 pediatric primary care clinic | Parents (of pediatric patients ≤12 years old) who smoke | Tobacco | Physicians/residents | 3919 patients (2024 pre-intervention and 1895 post-intervention) | Not a significant change in screening. There was a significant increase in counseling for parents who screened positive. |
Sterling et al., 2015 [48] | None | Cluster randomized controlled trial 2 years | United States | 1 pediatric primary care system | Adolescents 12–18 years old | Alcohol, tobacco, other drugs | Arm 1: Pediatricians Arm 2: Pediatricians and embedded behavioral health care practitioners Arm 3: Usual care | 1871 patients (584 in Arm 1, 671 in Arm 2, 616 in Arm 3) | In Arm 1, pediatricians who attended 2+ trainings assessed more patients than pediatricians who attended fewer trainings(p < 0.001) and provided more brief interventions (p < 0.001) than pediatricians who attended fewer trainings. The total number of assessments in Arm 1 and Arm 2 were not significantly different. Arm 1 and Arm 2 provided significantly more brief interventions than Arm 3 (p < .001) Arm 1 provided more brief interventions related to substance use than Arm 2 (p < 0.001). Arm 2 had significantly lower referral to treatment when compared to usual care (p = 0.006), but Arm 1 was not significantly different from usual care |
Thomas et al., 2016 [38] | None | Quality improvement (using Plan-Do-Study-Act) 12 months | United States | 1 emergency department and hospital | Adult trauma patients | Alcohol and other drugs | Multiple roles provided SBIRT (including nurses and health education specialists), and the process changed throughout the project | 1664 patients | The percentage of patients who were screened significantly increased over time from 47% (Quarter 1) to 86.1% (Quarter 2) (p < 0.001) Specialist-delivered SBIRT (assessment and brief intervention when applicable) did not significantly change over time. |
Whitty et al., 2015 [39] | None | Mixed-method, uncontrolled, pre-post trial 6 months (pre-intervention) 13 months (implementation) 6 months (post-intervention) | Australia | 1 hospital | Patients treated for alcohol-related injury and maxillofacial trauma; the majority of patients who met criteria at this hospital were Indigenous | Alcohol | Not specified (the best practice pathway was designed for medical, surgical and nursing departments) | 144 patients (76 pre and 68 post) | Screening significantly increased from 9 to 81% of patients (p ≤ 0.001). No significant change in brief intervention, internal referral, or external referral. |
Zimmermann et al., 2018 [40] | None | Quality improvementa 8 months | United States | 1 trauma center | Trauma patients 15+ years old | Alcohol | Blood alcohol levels used as a screening tool; if a patient screened positive (blood alcohol level > 0.02%) the social worker provided a brief intervention and evaluated for treatment services | 693 patients | Screening increased from 30% (month 1) to 100% (months 4–8). |