Aims. To compare experience of, and attitudes towards, implementation of alcohol SBIRT for opioid agonist patients in primary and specialty care settings, with or without a resident training initiative.
Methods. Two focus groups with 14 health care professionals were conducted at two clinics in Portland, Oregon. Participants included family physicians, family medicine residents, counsellors and social workers. Transcripts of the focus groups were analyzed thematically.
Results. The current and previous practice of managing problem alcohol use in primary and specialty care level is different, but complimentary. We identified organizational, structural, provider, patient and community related factors that hindered or fostered SBIRT implementation. The most salient factors were continuing education, access to specialist support staff, funding or reimbursement for SBIRT, and enhanced electronic medical records / clinic flows. These themes are compared and contrasted with similar work in Ireland.
Conclusions. Training health care professionals in delivering alcohol SBIRT is feasible and acceptable for implementation among opioid agonist patients; however, it is not sufficient to maintain a sustainable change. Effective implementation requires systematic changes at multiple levels targeting obstacles specific to patient population or setting. Research into multilevel interventions to encourage implementation of alcohol SBIRT in primary and specialty care settings is a priority.
Key words: alcohol, SBIRT, opioids, agonist treatment, methadone, family medicine, implementation