Attitudes, perceptions and practice of alcohol and drug screening, brief intervention and referral to treatment: a case study of New York State primary care physicians and non-physician providers.
OBJECTIVE
Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been endorsed by the United States Preventive Services Task Force as an evidence-based strategy to address risky alcohol use among adults in primary care. Nevertheless, very few healthcare professionals report using SBIRT in their practice. The purpose of this study was to explore attitudes regarding addressing substance use; perceptions of effectiveness, role responsibility, and self-efficacy; and current SBIRT practice among primary care physicians, nurse practitioners, and physician assistants to identify factors which may impact routine delivery of SBIRT in primary care.


METHODS
A cross-sectional design was used to meet study objectives. Responses of physicians and non-physician providers (nurse practitioners and physician assistants) were compared.


METHODS
Primary care members of three New York State physician, nurse practitioner, and physician assistant professional organizations were surveyed between October 2013 and November 2013.


RESULTS
Barely half of participants (57%) reported screening their patients for substance use, and less than half provided brief intervention (46%) or referral to treatment (47%). Using a standardized tool to screen patients for risky substance use and assessing readiness to change were practised least frequently. Compared to physicians, nurse practitioners and physician assistants felt less responsible for addressing substance use (P = 0.019), felt less comfortable discussing substance use (P = 0.004), had more negative attitudes toward addressing substance use (P = 0.015), and were less likely to conduct brief intervention (52% vs 32%; P < 0.0005) and referral to treatment (50% vs 70%; P = 0.001).


CONCLUSIONS
This study identifies important attitudinal and perceptual differences between physicians and non-physician providers which may be targeted by education and training and underscores an opportunity for using non-physician providers to conduct SBIRT.
Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, USA. Electronic address: brh24@nycap.rr.com.
B R
BR
Harris
Center on Addictions Research, University at Albany School of Social Welfare, University at Albany, State University of New York, 135 Western Avenue, Albany, NY 12222, USA.
J
J
Yu
D019973:Alcohol-Related Disorders / Q000175:diagnosis; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York; D009722:Nurse Practitioners / Q000523:psychology / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000523:psychology / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000523:psychology* / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011614:Psychotherapy, Brief / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000175:diagnosis; D014481:United States
Brief intervention; Early intervention; Physicians; Primary care; Referral to treatment; SBIRT; Screening; Substance abuse