AUSTIN, Texas — Providing substance-abuse intervention services for women, particularly in the setting of reproductive health centers, is critical to positive patient outcomes, and offering those services electronically is much less expensive and just as effective in reducing substance abuse as a clinician-delivered intervention, according to new research from the LBJ School of Public Affairs at The University of Texas at Austin published in the journal Addiction.
Health economist Todd Olmstead, an associate professor of public affairs at the LBJ School, assessed how screening, brief intervention and referral to treatment (SBIRT) delivered via a computer or iPad fared in helping women seeking routine care in reproductive health centers to lower or quit their use of cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication.
Working with Dr. Kimberly Yonkers, Dr. Ariadna Forray, Kathryn Gilstad-Hayden and Steve Martino of the Yale University School of Medicine, and Steven J. Ondersma of Wayne State University, Olmstead found that computer-delivered SBIRT (e-SBIRT) is likely to be a good value from both a patient and health care provider perspective.
“The American Congress of Obstetricians and Gynecologists recommends SBIRT in reproductive health settings, but very little was known about the best way to do this,” Olmstead said. “This study showed that delivering SBIRT using a computer works well along several dimensions in this setting. For example, patients reported strong satisfaction with e-SBIRT, and they reduced their substance use just as much using e-SBIRT as they did with traditional clinician-delivered SBIRT. And compared to its clinician-delivered counterpart, e-SBIRT offered several cost-reducing advantages, including much less clinician training and supervision.”
The study was the first to examine the cost-effectiveness of delivering SBIRT to women in reproductive health settings, and the first to examine the cost-effectiveness of SBIRT delivered by a computer versus a clinician in any medical setting.
The research team focused on 439 women who visited two urban, academic reproductive health clinics in New Haven, Connecticut. They were voluntarily screened for substance use during their regularly scheduled visits and reported using substances an average of 24 days out of the preceding four weeks. They were randomly assigned to enhanced usual care, e-SBIRT or clinician-delivered SBIRT. Eighteen percent of participants were pregnant.
All participants received information about local treatment resources, self-help and internet treatment resources and information on self-led abstinence. The e-SBIRT method allowed patients to move from screening directly into intervention on the same electronic device without needing a clinic worker to route them to additional assistance. In terms of average patient outcomes — i.e., reducing substance misuse — e-SBIRT scored about the same as SBIRT, yet was about as inexpensive as enhanced usual care.
“The results provide strong support for using e-SBIRT to follow The American Congress of Obstetricians and Gynecologists’ recommendations,” Olmstead said. “Hopefully, we’ll start seeing more reproductive health centers implementing e-SBIRT programs during the next few years.”
The full study can be viewed online in Addiction: https://doi.org/10.1111/add.14668