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Open Access Study protocol

Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians

Ginetta Salvalaggio8*, Kathryn Dong1, Christine Vandenberghe2, Scott Kirkland2, Kelsey Mramor3, Taryn Brown2, Marliss Taylor4, Robert McKim5, Greta G Cummings6 and T Cameron Wild7

Author Affiliations

1 Department of Emergency Medicine, University of Alberta, Room 565 CSC, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada

2 Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada

3 University of Toronto, Toronto, Ontario, Canada

4 Streetworks, 10116-105 Ave, Edmonton, AB, T0B 4J0, Canada

5 Edmonton South Side and Edmonton West Primary Care Networks, Edmonton, AB, Canada

6 Faculty of Nursing, 5–110 ECHA, University of Alberta, Edmonton, AB, T6G 0C1, Canada

7 School of Public Health, 3–277 ECHA, University of Alberta, Edmonton, AB, T6G 2G4, Canada

8 Department of Family Medicine, University of Alberta, 1702 College Plaza, Edmonton, AB, T6G 2C8, Canada

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BMC Health Services Research 2013, 13:108  doi:10.1186/1472-6963-13-108

Published: 22 March 2013

Abstract

Background

Screening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of patient and health care provider resources designed to enhance the capacity of health care providers to use SBIRT and improve patient engagement with health care.

Methods/Design

A nonrandomized, two-group, pre-post, quasi-experimental intervention design was used, with baseline, 6-, and 12-month follow-ups. Low income patients using alcohol and other drugs and who sought care in family medicine and emergency medicine settings in Edmonton, Canada, along with physicians providing care in these settings, were recruited. Patients and physicians were allocated to the intervention or control condition by geographic location of care. Intervention patients received a health care navigation booklet developed by inner city community members and also had access to an experienced community member for consultation on health service navigation. Intervention physicians had access to online educational modules, accompanying presentations, point of care resources, addiction medicine champions, and orientations to the inner city. Resource development was informed by a literature review, needs assessment, and iterative consultation with an advisory board and other content experts. Participants completed baseline and follow-up questionnaires (6 months for patients, 6 and 12 months for physicians) and administrative health service data were also retrieved for consenting patients. Control participants were provided access to all resources after follow-up data collection was completed. The primary outcome measure was patient satisfaction with care; secondary outcome measures included alcohol and drug use, health care and addiction treatment use, uptake of SBIRT strategies, and physician attitudes about addiction.

Discussion

Effective knowledge translation requires careful consideration of the intended knowledge recipient’s context and needs. Knowledge translation in disadvantaged settings may be optimized by using a community-based participatory approach to resource development that takes into account relevant patient engagement issues.

Trial registration

Northern Alberta Clinical Trials and Research Centre #30094

Keywords:
Addiction; Screening; Brief intervention; Family medicine; Emergency medicine; Underserved patients; Patient engagement