Citizens Health Initiative

Unhealthy Alcohol Use –SBIRT Conference Follow Up

July 24, 2008 Meeting Summary

Attended:Susan McKeown, Patti Fowler, Ray Goodman, Jim Shagelaris, Joe Harding, Suzanne Bulter, Viking Hedberg, Ardis Olsen, Tricia Lucas, Maria Gagnon, Susan Barnard, Alicia Soucy, Donna Fleming (via phone), John Bunker, Laura Davie

1)Those who participated in the SBIRT conference on June 24th were asked to share the major “take-away” from the event:

  1. Surprised by how many SBIRT initiatives are already happening in NH
  2. Took from the key-note-the number how could benefit from SBI
  3. Not aware of how much research is available to support SBIRT
  4. SBIRT occurs as part of a larger system- need to make sure the WHOLE system has capacity
  5. There is still not clear evidence on how to deliver pediatric SBIRT- more talk than evidence
  6. NH is behind MA and other states
  7. SBIRT is for alcohol AND other drugs

2)What has to happen for Hospitals to implement SBIRT:

  1. Start with one large hospital and one small
  2. Address economic impact to hospitals (is there research, what does it say)
  3. Need leadership engaged- raise awareness
  4. Identify champions and train them
  5. Alcohol and other drugs system needs to be a part of the effort
  6. Mental Health system needs to be part of the effort
  7. 3 year versus 5 year implantationstrategy- possible logic model from tobacco program
  8. Legislative mandate
  9. Who benefits from SBIRT financially (mcaid, law enforcement, schools, county corrections…)
  10. Use of St. Joseph’s Hospital ER model
  11. Marketing
  12. Possibility of providing incentives for early participation
  13. Information Technology needs to implemented in hospitals
  14. Training as a requirement in job descriptions so that when a person leaves the program can continue.
  15. Enhancement of data collection

3)What needs to happen for PCP’s to implement SBIRT:

  1. Understanding of the two main types of practices (systems vs. small operations)
  2. Reimbursement for care management once screening takes place
  3. Every letter needs a code
  4. Similar to the hospital list:
  5. Education
  6. Training
  7. Incentives
  8. Office wide understanding-who else besides the physicians can screen?
  9. What/how will screening benefit practice
  10. Regional models
  11. Concurrent plan with hospitals
  12. HIT/HIE needs to be enhanced
  13. Potential barrier: system change is difficult in PCP practices- many done have meetings to implement system changes.
  14. Alcohol and other drug and depression- screening implemented together- 15 different screening tools, one for each problem, will not work.
  15. Pilot structure which documents what steps a practice needs to take to implement SBIRT
  16. Tools: one set verses many- which one will be recommended and by whom?
  17. What would be the target population in a PCP setting
  18. Parent screening

4)Who are the stakeholders not here:

  1. Legislators
  2. Corrections
  3. Mental Health Leaders- State and Community Mental Health Centers
  4. Educational System-high schools both public and private
  5. Social Workers in ER’s
  6. Physician Assistants

5)Recommendations for next steps:

  1. Citizens Health Initiative is submitting a report to the legislator in Nov. Recommendation will be to implement SBIRT over the next 3-5 years.
  2. Look at what other states are doing for easy wins
  3. Learn from other PCP and hospital based initiatives that have been done
  4. Sustainability- $ for pilots but then how to fund long term system change
  5. What can each of us do- who, what, where
  6. Develop the economic case
  7. Develop communications plan
  8. Find short term planning money
  9. Implement changes in medical school and residency training programs for real change

6)Short term next steps and responsible party:

  1. Recommendation in Initiative report to legislator- Laura
  2. Find out from local foundations about applying for a planning grant- EFH and NHCF- John
  3. Arrange a meeting with Dr. Bernstein- 2 hour meeting in NH—John will contact Dr. Bernstein and Laura will arrange a location and possibility of taping or transmitting live
  4. John will call Palmer Jones from the Medical Society for a PCP and ER Physician recommendation to attend
  5. Shawn LaFrance should attend
  6. Group will let John know what times are not good for a September meeting with Dr. Bernstein.
  7. Fact Sheets on SBIRT: Tools for each letter, Systems needs, ethicality data,Cost- economic impact
  8. First one on what is SBIRT and economic picture between PCP and Hospital programs- Laura
  9. SBIRT group should meet in Oct to follow up on these action steps and develop next steps. The group would ultimately like to develop a plan for implementing a SBIRT pilot in PCP and hospital and then roll out SBIRT state wide. An Oct date will be determined soon.

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