Alcohol Screening and Brief Intervention via Employee Assistance Program

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Alcohol Screening andBrief Intervention
viaEmployee Assistance Program

• Ken Joslyn, MD, MPH
• Medical Director, Quality Population Health,
  Medica
• Special thanks to Greg Greenwood (MBH)
• George Washington University
• Ensuring Solutions to Alcohol Problems
• (Eric Goplerud Tracy McPherson)
• www.integratedbehavioralhealth.org

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SBI Screening Brief Intervention

• SBI is generally effective in treating chronic
  diseases such as smoking, obesity, diet and
  nutrition
• SBI for Alcohol Goal
• screen for hazardous and harmful drinking
• provider tailored brief interventions
• referrals, as appropriate

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SBI Screening Brief Intervention

• Alcohol SBIs consistently demonstrate
• Reductions in drinking
• Reductions in alcohol-related problems
• Reductions in healthcare utilization in high
  acuity healthcare services
• Alcohol SBI assessment
• Have been rigorously tested in a variety of
  medical settings and delivered by a wide range of
  providers

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Alcohol SBIs are Low-Cost Cost-Effective

• The cost of implementing alcohol SBI is modest
• 42 cents / patient screened
• ROI 4.3 1 in healthcare costs1
• i.e. ? 4.30 saved for each 1 invested in early
  intervention
• Higher ROI if include societal costs of ? MVA ?
  crimes due to alcohol
• Estimated ROI for 500 employees 47,030
• (includes estimate of insurance premium dollars
  spent, GWU, Alcohol Cost Calculator for
  Business2 )

1. Fleming MF et al Alcoholism Clinical
Experimental Research. 2002, 26(1)36-43. 2.
http//www.alcoholcostcalculator.org/roi/?pagemet
hodologyfleming_2002_b
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Medica EAP Telephonic Alcohol SBI Pilot

• Goal To test feasibility outcomes of
  translating alcohol SBI to EAP telephonic care
  setting
• Who Medica members (inbound clinical calls only)
• Utilizing World Health Organization alcohol
  screening brief intervention (SBI) protocol

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Medica EAP Telephonic Alcohol SBI Pilot

• Development process
• EAP Online Screening tool developed
• Training of EAP staff
• Train-the-trainer model starting with EAP
  supervisors
• Two sessions a) Conceptual overview, b) Online
  workflow practice
• Pilot launched August 4, 2008
• Follow-up QA support and supervision
• Ongoing evaluation
• Process evaluation for efficiency and eventual
  ROI
• Clinical outcomes for effectiveness

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Medica EAP Telephonic Alcohol SBI Pilot

• Partners / Collaboration
• Medica EAP and Behavioral Health Sciences
• Account Management
• George Washington University (GWU)Ensuring
  Solutions to Alcohol ProblemsEric Goplerud
  Tracy McPherson www.integratedbehavioralhealth.org
  

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Interim Screening Results 6 mo (8/4/08 2/15/09)

• 367 completed screens of 394 calls (93)
• 231 (63) females 136 (37) males
• Multiple reasons for not completed screens
  being assessed
• Of the 367 completed screens
• Risk 1 287 - 78 - - (no or low-risk drinking)
• Risk 2 41 - 11 - - (hazardous drinking)
• Risk 3 9 - 3 - - (harmful drinking)
  
• Risk 4 30 - 8 - - (abuse/dependence drin
  king)

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Interim Screening Results 6 mo (8/4/08 2/15/09)

• 22 at-risk - 80/367Positive screen for at-risk
  or higher drinking (gt Risk 2)
• 11 at high risk - 39/367Positive screen for
  high risk (Risk 3 or 4)
• 10 referred for substance use behavioral health
  services
• 81 to follow-up with EAP

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Why Alcohol SBI Is Important In Clinical Practice

• Providers trained to deliver
• ? face-to-face alcohol SBI
• Screen for alcohol problems 50 of time vs. 40
  control
• Deliver alcohol intervention 73 of time vs. 57
  control
• 13-34 reduction in average number drinks per
  week
• Provider intervention or treatment referral

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• We all need to be
• about this work !
• For the benefit
• of our patients
• and our society.
• Remember 22

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