Literature Collection

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that provides early integrated intervention and treatment to patients with Alcohol Use Disorder (AUD) and/or Substance Use Disorders (SUD). Three Primary Care Medical Homes (PCMHs) in North Texas were selected as pilot sites for a SAMHSA grant designed to integrate SBIRT into existing services. The goal of this program is to support the stabilization and community reintegration of individuals who present with SUD by providing them with a continuum of care from screening, to brief intervention, to brief treatment, to referral for more advanced services. Specific aims of the grant included: provide SBIRT services to eligible participants, decrease substance and alcohol use at 6-month follow-up, improve patient physical and behavioral health measured at 6 months, and decrease in emergency department visits and costs for program participants. This brief report examines project design, outlines the implementation strategies, and provides preliminary results.

Substance use remains a leading cause of preventable death globally. A model of intervention known as screening, brief intervention, and referral to treatment (SBIRT) was developed decades ago to facilitate time- and resource-sensitive interventions in acute care and outpatient settings. SBIRT, which includes a psychosocial intervention incorporating the principles of motivational interviewing, has been shown to be effective in reducing alcohol consumption and consequences in unhealthy drinkers both in primary care and emergency department settings. Subsequently, SBIRT for unhealthy alcohol use has been endorsed by governmental agencies and professional societies in multiple countries. Although most trials support the efficacy of SBIRT for unhealthy alcohol use (McQueen et al. in Cochrane Database Syst Rev 8, 2011; Kaner et al. in Cochrane Database Syst Rev 2, 2007; O'Donnell et al. in Alcohol Alcohol 49(1):66-78, 2014), results are heterogenous; negative studies exist. A newer approach to screening and intervention for substance use can incorporate initiation of medication management at the index visit, for individuals willing to do so, and for providers and healthcare systems that are appropriately trained and resourced. Our group has conducted two successful trials of an approach we call screening, treatment initiation, and referral (STIR). In one trial, initiation of nicotine pharmacotherapy coupled with screening and brief counseling in adult smokers resulted in sustained biochemically confirmed abstinence. In a second trial, initiation of buprenorphine for opioid dependent individuals resulted in greater engagement in treatment at 30 days and greater self-reported abstinence. STIR may offer a new, clinically effective approach to the treatment of substance use in clinical care settings.

BACKGROUND: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. AIM: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. DESIGN & SETTING: A systematic review of prescribing formularies in England and Wales. METHOD: A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. RESULTS: Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. CONCLUSION: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.

OBJECTIVE: The growing population of older adults with serious mental illness (SMI) faces significant unmet needs as they age. Despite the increasing prevalence of SMI among older adults, limited research has focused on their specific needs, particularly within racially and ethnically diverse populations. This study examines the self-reported needs of 746 adults aged 50 years and older using data collected between 2018 and 2022 from the Bridge, a supportive housing agency in New York. METHODS: Need was operationalized as reported difficulties older adults encounter with various functional domains, including activities of daily living, instrumental activities of daily living, and mobility tasks. Data were analyzed using the team-based and patient-centered Rapid and Rigorous Qualitative Data Analysis method. Identified themes were categorized according to the social determinants of health framework. RESULTS: The most frequently reported subcategories of needs included housing (17.4%), access to care (10.7%), and social support systems (7.9%). Many participants emphasized the need for stable, accessible housing. Difficulties in accessing healthcare included challenges in obtaining mental health services, medications, and specialized care such as dental and vision services. Difficulties in social support systems involved a need for stronger family connections, companionship, and community involvement. Additionally, maintaining independence (6.6%) and holistic well-being (6.1%) emerged as key concerns, with participants emphasizing the importance of self-sufficiency and overall mental and physical well-being. CONCLUSION: The findings of this study underscore the gap between existing supportive services and the multidimensional needs of racially and ethnically diverse older adults with SMI. Addressing these challenges requires integrated healthcare models, housing stability initiatives, and expanded social support programs to improve quality of life and long-term outcomes for this vulnerable population.

BACKGROUND: To investigate the impact of patient selection in different health sectors on sensitivities and specificities of psychosomatic questionnaires and clinical signs and symptoms (CSS) for predicting daily life impairment (DLI) in individuals after SARS-CoV-2 infection. METHODS: Secondary data analysis of three independent cross-sectional surveys in general population (n = 2828), fourteen primary care practices (n = 204), and rehabilitation hospital (n = 161). DLI and symptoms were captured using questionnaires. PHQ-15 (Patient Health Questionnaire-15) and SSD-12 (Somatic Symptom Disorder-12), PHQ-2 (Patient Health Questionnaire-2), GAD-2 (Generalized Anxiety Disorder-2), and FAS (Fatigue Assessment Scale) were used to assess somatic symptom disorder (SSD), depression, anxiety and fatigue. Diagnostic indices were calculated to predict DLI. RESULTS: The sensitivities of questionnaires and CSS increased, and specificities decreased from general population to practices and hospital. SSD-12 had a higher diagnostic odds ratio (dOR; 95 % confidence interval) (17.4; 12.6-24.0) in population than in practices (8.4; 3.6-19.7) or hospital (8.1; 1.7-31.7). FAS > 22 had higher dOR (15.0; 11.8-19.1) in population than in practices (5.3; 2.8-9.8) or hospital (4.8; 1.4-16.3). The pattern (population / practice / hospital) was similar in depression (9.2; 7.0-12.0 / 8.0; 3.6-18.1 / 12.2; 1.5-96.2) and anxiety (8.0; 6.0-10.8 / 2.4; 1.0-5.6 / 3.0; 0.6-14.1). Areas under the curves of questionnaires were highest in population, followed by hospital, and consistently lower for practices. CONCLUSION: There is a large variation in sensitivities and specificities to predict DLI. The extent to which SSD or psychosomatic comorbidity contributes to DLI varied across the health sectors in which patients are diagnosed and treated.