Background/Aims Substance abuse in the United States is a serious public health concern; however, primary care physicians do not identify or intervene with substance use disorders for a variety of reasons including lack of time, lack of adequate training, and organizational factors. Prior to formal dissemination and implementation in KPCO and other healthcare systems, we conducted a small-scale qualitative evaluation of Kaiser Permanente Colorado (KPCO) provider and patient perceptions of the Substance Abuse and Mental Health Services Administration (SAMHSA) Screening, Brief Intervention and Referral to Treatment (SBIRT) tool. This is the first in a series of three pilot projects and was designed to learn about stakeholder reactions to SBIRT at KPCO.

Methods Interviews and focus groups were conducted with KPCO physicians, nurses, therapists, patients, and operational leadership from the following departments: Internal Medicine, Family Medicine, Chemical Dependency, primary-care based Behavioral Medicine Specialists (BMS), and Behavioral Health. Focus group findings were discussed by the project team each week, and questions were then tailored for subsequent focus groups/interviews. One additional focus group each was conducted with English-speaking and Spanish-speaking KPCO patients.

Results Overall, there is no systematic, standardized method of screening for drug and alcohol abuse at KPCO and knowledge of SBIRT was inconsistent and mostly superficial. Most focus group and interview respondents agreed that screening is necessary and that SBIRT is a good fit with current routine practice and organizational goals, however, a well-established workflow not requiring increased time from primary care physicians would be needed. Most felt that BMSs were best suited for SBIRT implementation. Patients were generally supportive of SBIRT and the educational value of the initial screening questions although English and Spanish-speaking patients differed regarding current screening and privacy concerns.

Discussion Utilizing SBIRT for routine screening for drug and alcohol use is feasible at KPCO if workflows are carefully constructed and all stakeholders are properly involved. Pilot implementation of SBIRT at KPCO is underway as informed by the pre-implementation interview and focus group findings. This qualitative process will be utilized in the third pilot to determine feasibility at another healthcare system.