Access Community Health Network is taking an integrated, standardized approach to helping patients with alcohol and substance use disorders. With the continuation of a program that is supported by grants from The Chicago Community Trust and the U.S. Department of Health and Human Services, ACCESS uses routine tests to help patients. Just as checking blood pressure can reveal health issues and guide recommendations for a healthier lifestyle, universal screening for alcohol and substance use helps ACCESS clinicians recognize an existing health problem before it worsens or becomes fatal.
ACCESS has adapted SBIRT as its universal screening model. SBIRT stands for Screening, Brief Intervention and Referral to Treatment and is a method for delivering early intervention and treatment services to people with, or at risk of developing, alcohol and substance use disorders. "We've trained our providers and care team members to administer best practice screening tools that assess for problematic alcohol and substance use," said ACCESS Director of Behavioral Health Suzanne Snyder. "This is done in an atmosphere that reduces the stigma and educates our patients to expect this service as part of their comprehensive primary care visit."
By implementing universal screening, ACCESS helps reduce the number of people who move from alcohol and substance use to addiction. If patients are identified as having potential alcohol or substance use problems, ACCESS' behavioral health consultants raise the patient's awareness by educating them about potential medical consequences and encouraging positive behavioral changes.
"This helps us to identify at-risk patients and those who are possibly at risk. Based upon the initial screening, the provider is able to take that conversation further and is able to recognize certain red flags that patients may have," Charles Barron, M.D., ACCESS Regional Medical Director, said. "The medical assistants do the initial screening and then based on that, the provider is alerted."
During the brief intervention stage, patients who have been identified as having potential problems are interviewed to explore their level of substance or alcohol use. They are also informed about the potential medical consequences. They are given assistance with assessing their readiness to make changes; strengthening problem-solving skills; initiating and maintaining behavioral change; and helping them build supportive social environments.
The next step to healthy lifestyles within the SBIRT model is referral to treatment. Patients who are at high risk for drug addiction are offered referrals to treatment programs within ACCESS that include participation in ACCESS' Suboxone program. This program provides medication and counseling for people working to overcome opioid addictions. If this isn't an option, then patients are referred to outpatient treatment at local partner hospitals.
"Depending on what stage they are in, some people may be able to manage their addictions as an outpatient," Dr. Barron said. "But those patients who have been using stronger drugs may experience significant withdrawals, and that patient may need more intensive care, which could include stabilization at a hospital and then into outpatient treatment."
When it comes to lifestyle changes, certain cultural traditions or habits are often taken into account, Dr. Barron said. "In certain cultures, having four or five beers a day is fine, and the patient or their family might not think that anything is wrong. But when you haven't gone a week without a beer for two years, then it becomes a problem, and it is affecting you physically. You are essentially a functional alcoholic," he said. "SBIRT opens the door for the conversation about dependencies. Some patients may come in and admit their dependencies, but some patients may not feel comfortable and welcome the opportunity to reach out."
It is not just the primary care physician that looks out for the patient, but the care team approach encourages collaboration between providers and patients, as they work together toward the best possible health outcomes and a healthier lifestyle for patients. SBIRT also increases the integration of behavioral health care within primary care, which is a hallmark of ACCESS' nationally recognized patient-centered medical home (PCMH) model.
Through the SBIRT program, ACCESS makes sure that patients have the support that they need to come up with a treatment plan that the patient can adapt and successfully complete. "Follow through is key," said Dr. Barron. "We understand that many patients coming through the SBIRT program are the major breadwinners in their families, and we have to consider these things, so that their households are still intact, even as they seek treatment."
For more information about ACCESS' SBIRT program, call Rosalind McGee, Supervisor of SBIRT II, at 312.526.2111.
About Access Community Health Network
Designated as a Level 3 patient-centered medical home by the National Committee for Quality Assurance (NCQA), ACCESS offers patient-centered, preventive and primary care services to more than 175,000 patients annually. Through its investment in technology to further improve patient care and engagement, ACCESS has also been recognized by HIMMS at Stage 6 for its adoption of its electronic health record. With 35 Joint Commission-accredited community health centers located throughout Chicago and the surrounding suburbs, ACCESS is also one of the largest networks of community health centers in the nation. For more information, visit: www.achn.net.