Bringing Research to the Community
Addressing Inequalities with Creative Strategies
For more than a decade, Judith and Edward Bernstein have provided training to health care professionals from across the country in how to use a “brief, nonjudgmental conversation” to identify and begin treating substance abuse in patients admitted to emergency departments. They are currently working with staff at seven hospitals in Massachusetts.
When Edward Bernstein, professor of emergency medicine at the School of Medicine (BUSM) and professor of social and behavioral sciences at the School of Public Health (SPH), and his wife, Judith Bernstein, associate professor of maternal and child health at SPH and associate professor of emergency medicine at BUSM, put an older method of treating substance abuse into a new context the results were so successful that emergency departments around the country followed their lead.
For more than a decade, the Boston Medical Center has used the Screening, Brief Intervention to Referral and Treatment (SBIRT) strategy in its emergency department (ED). Long used as part of routine health care, this technique—which is designed to encourage substance abusers to seek appropriate treatment—had not previously been applied in an emergency medicine setting. Now, thanks to a grant from the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, seven hospitals around the state are implementing SBIRT in order to take advantage of the unique environment EDs provide.
It started with the Bernsteins' realization that, somewhat counterintuitively, a visit to the emergency room can be a good time to start a conversation about controlling drug and alcohol use. Individuals are more likely to self-report substance abuse when they enter treatment than when they exit, so a patient who has been recently admitted to the ED is likely to be receptive to SBIRT. Moreover, individuals admitted to an emergency department are one and a half to three times more likely to report substance abuse than those seeing primary care physicians.
Edward Bernstein credits the success of the SBIRT approach to the unique conditions present in an emergency department as well as to the commitment of ED staff. “Massachusetts offers some of the best conditions for improving quality of care for ED patients,” he says. “It's not only that we have a real commitment to medical innovation and advanced technology. This is also a state that is using creative strategies to address inequalities in access and to promote quality in health care services.”
The Bernsteins instituted Project ASSERT at the Boston Medical Center in 1993 to provide training for health care professionals from across the nation in the SBIRT model. Today, they continue to train professionals in this simple yet effective technique through the Brief Negotiated Interview and Appropriate Referral to Treatment (BNI-ART) Institute, which recently received a three-year, $2.25 million grant from the Massachusetts Department of Health. Twenty-six hospitals applied to participate in the first round of funding, with seven selected to receive training.
Edward Bernstein is not surprised by the interest in SBIRT, which “involves a brief, respectful, nonjudgmental conversation about the risk of unhealthy alcohol and other drug use and the negotiation of low-risk drinking limits or abstinence.” Person-to-person interviews have resulted in a measurable drop in levels of substance abuse. “Transnational research,” Edward Bernstein says, “including our own recent multi-center ED study, has demonstrated a reduction of 3.25 drinks per week among excessive drinkers.”
For more information, see www.ed.bmc.org/sbirt/index.htm.
