Hi I need 2 peer responses. Please include 1 scholarly article in response. Response could be 1-2 paragraphs.
Peer 1
Article may be found here: https://onlinelibrary.wiley.com/doi/full/10.1111/add.13676Links to an external site.Description of the purpose
This cross-site evaluation explores the efficacy and feasibility of implementing universal Screening Brief Intervention Referral to Treatment (SBIRT) for all adult patients in diverse settings.
Explanation of research design
As part of their SBIRT initiative, the Substance Abuse and Mental Health Services Administration (SAMHSA) has funded 7 cycles of SBIRT studies across 29 states, 2 tribal councils, and 1 US Territory. This study analyzes two cohorts totaling over one million people from 9 states and 2 tribal organizations: California, Georgia, Illinois, Missouri, New Mexico, Pennsylvania, Texas, Washington, West Virginia, the Alaskan Cook Inlet Tribal Council, and the Alaskan Tanana Chiefs Conference. Performance sites included schools, health fairs, treatment facilities, in- and out-patient hospital services, ambulatory clinics, and emergency departments/trauma centers. All patients seen were screened for mental health/substance use disorders using an SBIRT approach. First a pre-screen was conducted in order to determine if a full screen was required. If so, an evidence-based questionnaire was administered by a healthcare professional (PCP, APRN, PA, RN, SBIRT trained person), and scored according to the questionnaire’s rubric. Those at low-moderate risk were given a brief intervention lasting anywhere from 1-6 sessions. Those at moderate-high risk were given a brief treatment session, lasting anywhere from 2 to an unlimited number of sessions. Lastly, those at severe risk or those who were actively dependent on drugs/alcohol were referred to a higher level of care at a treatment canter. SAMHSA prohibited the use of control or comparison groups.
Discussion of sample
Cohort one took place from 2003-2008, consisted of 528,036 people, and included those from California, Illinois, New Mexico, Pennsylvania, Texas, Washington, and the Alaskan Cook Inlet Tribe. 56.2% were female with an average age of 43.6 years. 47.7% identified as white, and disproportionate number of minority groups were included, with 28.2% identifying as Hispanic and 26.2% identifying as black. 22.4% screened positive for substance use, with 74.4% of those using alcohol, and 41.8% of positive screens reporting illicit drug use; 30% were dual substance users.
Cohort two took place from 2008-2013, consisted of 489,396 people, and included those from Georgia, Missouri, West Virginia, and the Alaskan Tanana Chiefs Conference. 55.9% were female, 65.6% identified as white, and 23.3% identified as black. 11.1% screened positive for substance use, with 80% of those using alcohol, and 45.8% of positive screens reporting illicit drug use; 32.1% were dual substance users.
Description of data collection methods
Data were collected on site and processed by the AVISA Group, JBS International, RTI International, and the University of Connecticut School of Medicine using a mixed-method approach. They collected and analyzed information on who provided which SBIRT services to whom, then investigated barriers to and facilitators of treatment as well as how the grant recipients’ models changed over time and the results thereof.
Summary of findings
Barriers to and facilitators of implementation fell within 6 categories, according to staff surveys: Quality assurance (staff training and monitoring), leader commitment, proper lines of communication, provider acceptance, patient populations, and grant requirements (quotas and data collection mandates). Without the use of a control group, comparisons are difficult to make, and causality cannot be inferred; however, pre-post differences were statistically significant for almost every measure of substance use, including a 72% decrease in heavy drinking, and 80% decrease in illicit drug use, with more intense and thorough interventions associated with larger decreases in substance use. Brief interventions, usually lasting fewer sessions than brief treatments, were shown to be more effective with alcohol use, while brief treatments were shown to be more effective with substance use; therefore, brief intervention was associated with a reduced cost, with brief treatment costing an average of $8.90 per 1% reduction of substance use. Lastly, the SBIRT service model was shown to be sustainable after funding ended, with 69 (67%) of performance sites adapting their own SBIRT delivery model.
Strengths of the study
This is the single largest study of SBIRT implementation, with over a million patients studied over a 10-year period. Those studied included a diverse population across many states and a diverse socioeconomic landscape. The lack of a control group and rigorous standards allowed researchers to organically change their designs to fit their unique populations, thus enhancing patient centered care while allowing for more broad and timely implementation.
Limitations of the study
The lack of a control group and rigorous standards means only correlations can be drawn, and no direct causality can be confirmed. This makes it impossible to confirm by standard means that an SBIRT approach is the only thing driving up patient treatment while driving down substance use.
Recommendations
This studies’ size and complexity provides a true macro view to the issue of substance use. The lack of a control group is a drawback in standard scenarios, but in this instance, allows researchers to analyze the natural evolution of program implementation over the 5-year study period. There will never be a one-size-fits-all solution or approach capable of matching the complexities of mental health and substance use; as such, allowing for these natural changes and divergences to occur provides a more thorough understanding of the utility of an SBIRT approach in a real-world scenario.
References:
Bray, J.W., Del Boca, F.K., McRee, B.G., Hayashi, S.W., Babor, T.F. Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross-site evaluation. Addiction, 112(52), 3-11. https://doi.org/10.1111/add.13676Links to an external site.
Peer 2
Article title: What Works for Managing Chronic Pain: An Appreciative Inquiry Qualitative Analysis
Authors: Jodi Holtrop, Mary Fisher, Doreen Martinez, Matthew Simpson, Nida Awadallah, Donald Nease, Linda Zittleman & John Westfall
Journal: Journal of Primary Care Community Health
Date published: November 21st, 2019
Reference:
Holtrop, J. S., Fisher, M., Martinez, D. E., Simpson, M., Awadallah, N. S., Nease, D. E., Zittleman, L., & Westfall, J. M. (2019). What works for managing chronic pain: An appreciative inquiry qualitative analysis. Journal of Primary Care Community Health, 10. https://doi.org/10.1177/2150132719885286 Links to an external site.
Purpose: The goal was to first find patients who had beneficial experiences to share; individuals who were able to report functional lives, though not always devoid of pain. In this study, people with chronic pain who could do “most of what they want on most days” were interviewed to learn about effective pain management techniques. The study was conducted with a total of 24 individuals, from ages 25 to 77 and a pain duration from 3 to 63 years.
Research design: Prior to assigning any codes, the core team members independently went through several transcripts to create words and definitions. This went on until coding standards were established and a coding manual was created. After the coding was finished, the qualitative core analysis team met twice a week for four months to finish the study. The seven emergent dominant treatment codes: (1) medications, (2) chronic pain-specific medications, (3) physical therapy/exercise, (4) prayer/meditation/relaxation, (5) self-care, (6) alternative care, and (7) procedure were examined and analyzed, and it became clear that patients employed a range of strategies to effectively manage their pain depending on their unique circumstances and surroundings.
Discussion of sample: A total of 24 patients were interviewed and used for this study. Ages were from 25 to 77 years old, 20 females and 4 male patients. Talking about race, there were 9 white, 10 African American, 3 Hispanic and 2 mixed race patients. These individuals have experienced pain from 3 years to 63 years.
Data collection methods: The Colorado Multiple Institutional Review Board gave its blessing to this qualitative, descriptive study. The individuals who participated in this study were recruited from health care and community settings in the Denver, Colorado area. The research team consisted of 2 female PhD-level methodologists, a male doctor and a female master’s degree prepared assistant.
Findings: The results suggest that it may be advantageous to discuss pain management preferences with patients in order to assist each person find numerous approaches that are effective for them. With the patient at the center and the clinician and team using a holistic approach to find techniques that are pertinent to each individual, this strategy fosters patient-centered care.
Strength: Numerous qualitative research on chronic pain and its management have been carried out, however the bulk of these studies have concentrated on the amount of treatment, communication issues between healthcare providers, or challenges with pain management. In comparison with those other studies, the strength of this study was that self-identified successful chronic pain patients used a variety of strategies along with motivating and affirming beliefs, important close relationships, and healthcare professionals to overcome the limitations brought on by their chronic pain.
Limitation: The first objective of this study is to increase our depth and significance of our comprehension on patients’ experiences of chronic pain. Because of this, the particularity of age group, gender, or race were not expected to be disclosed. This is a limitation to the study as important information like that, could affect the study’s outcome.
