title: The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility.
abstract: BACKGROUND
  Screening, brief intervention, and referral to treatment (SBIRT) is effective for reducing risky alcohol use across a variety of medical settings. However, most programs have been unsustainable because of cost and time demands. Telehealth may alleviate on-site clinician burden. This exploratory study examines the feasibility of a new Remote Brief Intervention and Referral to Treatment (R-BIRT) model.
  
  
  METHODS
  Eligible emergency department (ED) patients were enrolled into one of five models. (1) Warm Handoff: clinician-facilitated phone call during ED visit. (2) Patient Direct: patient-initiated call during visit. (3) Electronic Referral: patient contacted by R-BIRT personnel post visit. (4) Patient Choice: choice of models 1-3. (5) Modified Patient Choice: choice of models 1-2, Electronic Referral offered if 1-2 were declined. Once connected, a health coach offered assessment, counseling, and referral to treatment. Follow up assessments were conducted at 1 and 3 months. Primary outcomes measured were acceptance, satisfaction, and completion rates.
  
  
  RESULTS
  Of 125 eligible patients, 50 were enrolled, for an acceptance rate of 40%. Feedback and satisfaction ratings were generally positive. Completion rates were 58% overall, with patients enrolled into a model wherein the consultation occurred during the ED visit, as opposed to after the visit, much more likely to complete a consultation, 90% vs. 10%, χ(2) (4, N=50)=34.8, p<0.001.
  
  
  CONCLUSIONS
  The R-BIRT offers a feasible alternative to in-person alcohol SBIRT and should be studied further. The public health impact of having accessible, sustainable, evidence-based SBIRT for substance use across a range of medical settings could be considerable.
authors: University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Edwin.Boudreaux@umassmed.edu.
authors: Edwin D
authors: ED
authors: Boudreaux
authors: University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: Brianna.Haskins@umassmed.edu.
authors: Brianna
authors: B
authors: Haskins
authors: Polaris Health Directions Inc., 565 E. Swedesford Rd. #200, Wayne, PA 19087, USA. Electronic address: tharralson@polarishealth.com.
authors: Tina
authors: T
authors: Harralson
authors: Boston University School of Medicine, 77 Albany St., Boston, MA 02118, USA. Electronic address: Edward.Bernstein@bmc.org.
authors: Edward
authors: E
authors: Bernstein
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control* / Q000523:psychology; D003376:Counseling; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D062405:Motivational Interviewing; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016730:Program Development; D012017:Referral and Consultation; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors
keywords: Brief motivational intervention; Referrals; Screening; Substance abuse; Technology; Telehealth