Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) under the Affordable Care Act
Untreated substance use disorders (SUDs) place individuals at significantly greater risk for a wide range of diseases and are a significant public health burden, yet only one tenth of Americans with SUDs received treatment in 2012. An anticipated effect of new standards related to essential health benefits under the 2010 Affordable Care Act (ACA) and recent parity laws (i.e., requiring addiction services be covered to the same extent as other types of mental and physical health care) is that this pervasive treatment gap may be reduced by expanding SUD-care services in primary care services, particularly in medically underserved and low- income populations. As outlined in a new commentary by researchers with NIDA’s Center for the Clinical Trials Network, this vast expansion of preventive substance-use-care services in primary care presents major challenges that will need to be met in the areas of training, infrastructure, and research. Specifically, physicians and other staff in primary care settings will need to become suitably trained in screening, brief intervention, and referral to treatment (SBIRT) for SUDs, and primary care settings will need to adopt and use validated screening and brief assessment tools that are standardized for integration into electronic health records. Implementation-science research will need to be conducted in order to develop suitable performance metrics that can enable standardized delivery of treatment plans, to create and effectively use patient registries, and to determine how best to use new health information technology to effectively deliver SUD care services to all populations needing it.
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