Abstract
Objectives
Universal screening for substance use during pregnancy, brief intervention, and referral to treatment (SBIRT) is recommended by ACOG and the USPSTF. Here we present the implementation of SBIRT into the electronic health record (EHR) to inform clinical intervention and collect data on the prevalence of substance use during pregnancy at three prenatal clinics.
Methods
A literature-based SBIRT instrument was developed. The tool was integrated into the EHR of a resident Ob/Gyn clinic, an MFM practice, and an Ob/Gyn generalist practice at our institution, an academic, tertiary care medical center in an urban area, and automated reports of aggregate retrospective EHR data were used to monitor patient responses to SBIRT over time. Data reports included patient responses to screening for substance use, brief intervention, and referral to treatment from January to December 2018
Results
An interprofessional team of health care providers and systems analysts guided the SBIRT implementation process. As of December 2018, overall SBIRT performance during prenatal care encounters was 1797/2619 (69%), 432/1350 (32%), and 1290/1518 (85%) in the resident clinic, MFM practice, and generalist practice, respectively. Eighty (5.1%) women in the resident clinic, 2 (0.5%) in the MFM practice and 14 (1%) in the generalist practice reported past or present substance use.
Conclusions for Practice
Integrating universal SBIRT into prenatal care using the EHR requires a multi-disciplinary approach. The SBIRT tool facilitates reportable substance use screening, brief intervention, and referral to treatment during prenatal care. Future reports will further characterize substance use in our prenatal practices and inform intervention strategies in this population.
This is a preview of subscription content, log in via an institution to check access.
References
ACOG. (2017). Committee opinion no. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics & Gynecology,130(2), e81–e94.
Center for Adolescent Substance Abuse Research. (2009) Children’s Hospital Boston. The CRAFFT screening interview. Boston (MA): CeSAR. Retrieved April 30, 2019 from https://www.ceasar.org/CRAFFT/pdf/CRAFFT_English.pdf
Chasnoff, I. J., Landress, H. J., & Barrett, M. E. (1990). The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. The New England Journal of Medicine,322(17), 1202–1206.
Ewing, H. (1990). A practical guide to intervention in health and social services with pregnant and postpartum addicts and alcohol- ics: Theoretical framework, brief screening tool, key interview questions, and strategies for referral to recovery resources. Martinez (CA): The Born Free Project, Contra Costa County Department of Health Services.
Guttmann, A., Blackburn, R., Amartey, A., Zhou, L., Wijlaars, L., Saunders, N., et al. (2019). Longterm mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel cohort study in England and Ontario Canada. PLoS Medicine,16(11), e1002974. https://doi.org/10.1371/journal.pmed.1002974.
Hser, Y. I., Kagihara, J., Huang, D., Evans, E., & Messina, N. (2012). Mortality among substance-using mothers in California: A 10-year prospective study. Addiction,107(1), 215. https://doi.org/10.1111/j.1360-0443.2011.03613.x.
Jonas, D. E., Garbutt, J. C., Amick, H. R., Brown, J. M., Brownley, K. A., Council, C. L., et al. (2012). Behavioral counseling after screening for alcohol misuse in primary care: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine,157(9), 645–654.
Kahila, H., Gissler, M., Sarkola, T., Autti-Ramo, I., & Halmesmaki, E. (2010). Maternal welfare, morbidity and mortality 6–15 years after a pregnancy complicated bxfy alcohol and substance abuse: a register-based case-control follow-up study of 524 women. Drug and Alcohol Dependence.,111(3), 215. https://doi.org/10.1016/j.drugalcdep.2010.04.014.
National Institute on Drug Abuse. Resource guide: screening for drug use in general medical settings. Retrieved May 22, 2019 from https://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen
Osterman, M. J. K., & Martin, J. A. (2018). Timing and adequacy of prenatal care in the United States, 2016. National Vital Statistics Reports 67. Hyattsville, MD: National Center for Health Statistics.
Patrick, S. W., Davis, M. M., Lehmann, C. U., & Cooper, W. O. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology,35(8), 650–655.
SAMHSA (2017). The National survey on drug use and health: 2017. Rockville (MD): Substance abuse and mental health services administration. Retrieved January 2, 2020 from https://www.samhsa.gov/data/sites/default/files/nsduh-ppt-09-2018.pdf.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety,23(4), 290–298. https://doi.org/10.1136/bmjqs-2013-001862.
USPSTF. (2009). Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine, 150(8), 551–555. Retrieved May 21, 2019 from https://www.ncbi.nlm.nih.gov/pubmed/19380855
Viteri, O. A., Soto, E. E., Bahado-Singh, R. O., Christensen, C. W., Chauhan, S. P., & Sibai, B. M. (2015). Fetal anomalies and long-term effects associated with substance abuse in pregnancy: A literature review. The American Journal of Perinatology,32(5), 405–416.
Wright, T. E., Terplan, M., Ondersma, S. J., Boyce, C., Yonkers, K., Chang, G., et al. (2016). The role of screening, brief intervention, and referral to treatment in the perinatal period. American Journal of Obstetrics and Gynecology,215(5), 539–547.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hostage, J.C., Brock, J., Craig, W. et al. Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) for Substance Use into Prenatal Care. Matern Child Health J 24, 412–418 (2020). https://doi.org/10.1007/s10995-020-02892-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-020-02892-9