Implications of Team-Based Approach to Screening and Brief Intervention for Unhealthy Alcohol and Other Drug Use

The use of health educators to perform screening and brief intervention (SBI) for unhealthy alcohol and other drug use among primary care patients has the potential to decrease the burden on clinicians. This study sought to determine how reliably primary care clinicians’ notes document SBI as delivered by a health educator. Researchers performed a retrospective chart review of the Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT) program. Health educators completed a paper communication form to convey the results of the screening and brief intervention to clinicians. Of 3905 unique primary care patients screened by health educators during the 6-month study period, 13% (495 patients) screened positive for unhealthy alcohol (>3 drinks in a day for women, >4 drinks in a day for men) or other drug use.

• Sixty-nine percent of primary care clinician notes documented information related to screening data obtained by health educators.
• Clinician documentation was 100% for patients with likely dependent alcohol or other drug use, but only 64% and 59% for those with risky alcohol or other drug use, respectively.
• Clinician documentation of cocaine or opioid use was greater than that of alcohol or marijuana use.

Comments:

A team-based approach to health care is an appealing option. However, this study demonstrates that sharing of information among team members may suffer as a result of divisions of labor. The impact of these “handoffs” on care delivery is not known. Electronic medical records with shared documentation capabilities may address some of this fragmentation of care.

Jeanette M. Tetrault, MD

Reference:

Kim TW, Saitz R, Kretsch N, et al. Screening for unhealthy alcohol and other drug use by health educators: do primary care clinicians document screening results? J Addict Med. 2013;7(3):204–209.