From the “War on Drugs” to the rise of prescription opioid overdoses to the scourge of heroin abuse to the more common tobacco and alcohol abuse, the US medical system continues to struggle with how to curb a substance abuse epidemic. Medical statistics now demonstrate a shocking fact that more Americans are dying from drug overdoses than motor vehicle accidents. Furthermore, some patients are seemingly averse to discussing the issue similar to trying to get patients to exercise more and stop smoking. How can we help patients in the front lines of busy emergency rooms and primary care clinics?
Over the years, much research has gone into patient activation, shared decision making and motivational interviewing as forms of brief interventions that can be provided at the point of care. One of the most popular and most evidence based tools is SBIRT: Screening, Brief Intervention, and Referral to Treatment for Substance Use. I first learned about SBIRT while Program Director at Fort Hood, TX.
My residents and faculty were all trained in the techniques and required to screen patients admitted to the inpatient service for substance abuse. We also received training for motivational interviewing and SBIRT for tobacco and alcohol use/abuse in the outpatient clinic setting. Over the years, this has caught fire and now the US Army has greatly expanded the program. Every provider in my hospital just completed training in the use of SBIRT to assist patients in cutting down on problem alcohol use. Recently here on iMedicalApps we reviewed an app called PEPtools that utilized the concepts of motivational interviewing and patient activation for weight management and gout.
The app walks you through a typical SBIRT interaction from screening to brief intervention and referral to treatment. First, the app prompts you to choose if you are evaluating an adult or a child/adolescent. Next you are guided to ask validated screening questions regarding tobacco use, alcohol use and prescription/illicit medications. The app then takes you through a sequence of recommended brief interventions (motivational interviewing) for each positive substance category identified during screening. The app includes a number of built in, validated screening tools including the AUDIT for alcohol use and the DAST for drug use. For children and adolescents the app uses the validated CRAFFT survey.
For the Brief Intervention and Referral to Treatment sections of the app, it guides you through the use of the “readiness ruler” to assess patient readiness for change and how to perform motivational interviewing to help the patient choose to make positive change and accept referral for treatment.
Evidence based medicine
There is robust evidence to support the SBIRT approach. The app uses validated screening tools such as the AUDIT, DAST and CRAFFT. However, the mobile app does not contain any references or links to the supporting evidence for SBIRT which is unfortunate.
What providers would benefit from this App?
Students, residents, mid-levels, primary care providers, emergency physicians, mental health providers, any provider who may identify problem substance use and need to be able to properly screen, intervene and refer these patients. There is a free SBIRT course available through Medscape.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Utilizes a proven and established approach to substance use.
- User interface guides you through the entire SBIRT interaction.
- Screening tools built right into the app.
- No evidence or references to support material in the app.
- No links to referral centers or other resources to help patients who agree to referral.
- Directions for use are sufficient but a video tutorial or links to examples would be better.
SBIRT is a well-designed app that functions as an indispensable companion tool for any provider who has received training in SBIRT. The app is laid out in an intuitive fashion that can guide the novice or expert in completing an SBIRT interaction at the point of care in an efficient fashion. Pending further studies and increased evidence of efficacy, the SBIRT approach has the potential to truly turn the tide on substance use in our country.
- Overall Score
- User Interface
Design is simple, but elegant in the manner in which it guides providers to complete an SBIRT interaction.
- Multimedia Usage
Validated screening tools and ‘readiness rulers” are built into the app for POC use. The app lacks links for referral/treatment centers or references/evidence on the SBIRT techniques.
App is free with funding from SAMHSA.
- Real World Applicability
A simple app that could change many providers’ approach to patients with substance use and truly positively impact care and reduce healthcare costs.
- Device Used For Review
iPhone 6 running iOS 8.4.1
- Available for DownloadiPhoneiPad