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Substance use and abuse added to emergency room screening

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In February 2016, Stony Brook University Hospital unveiled a new program that screens every person who comes into the emergency department for alcohol, drug and tobacco use with a short questionnaire. Stony Brook hospital is one of 11 hospitals in Suffolk participating in the state's Delivery System Reform Incentive Payment program, or DSRIP, created to improve care and reduce costs for low-income Medicaid patients. (Credit: Randee Daddona)

Katie Sinnott has seen results in a few weeks.

The addiction counselor at Stony Brook University Hospital is part of a new program, started on Feb. 16, that screens every person who comes into the emergency department — regardless of the reason he or she is there — for alcohol, drug and tobacco use with a short questionnaire. Already, she said, two people who came to the emergency department because of other chronic diseases have been referred to substance abuse programs.

“It’s been a very positive experience,” she said.

And one that is set to expand.

All 11 hospitals in Suffolk will be offering the same program over the next 18 months as part of the state’s Delivery System Reform Incentive Payment program, or DSRIP. Under DSRIP, up to $6.42 billion will go to safety net or public hospitals and their community collaborators statewide over the next five years if they cut avoidable hospital use among Medicaid recipients by 25 percent by the end of 2019.

Stony Brook is the lead organization in Suffolk and the questionnaire is one of its 11 DSRIP projects.

“This is a big, big deal,” said Kristie Golden, associate director of Operations, Neurosciences, Neurology, Neurosurgery & Psychiatry for Stony Brook Medicine, who is coordinating the program, the only one in the state. Brookhaven Memorial Hospital Medical Center in Patchogue is on tap to open its program later this month, she said.

Emergency departments are a logical place to use the questionnaire because they often see the direct or indirect impact of substance use or abuse. Up to 40 percent of all hospital beds in the United States — except for those being used by maternity and intensive care patients — are being used to treat health conditions related to alcohol consumption, according to the National Council on Alcoholism and Drug Dependence.

Alcoholism is the third leading lifestyle-related cause of death and tobacco is the first, according to the Centers for Disease Control and Prevention. In 2014, 2.9 percent of New Yorkers aged 12 or older were dependent on or abused illicit drugs within the year before being surveyed, a percentage that has not changed significantly since 2010, according to the Substance Abuse and Mental Health Services Administration.

Suffolk has a higher percentage of current drinkers than the state or national average, according to a 2014 community needs assessment done by Stony Brook and others as part of its DSRIP application. Tobacco use is higher in the county than the nationwide average, the report found, and the percent of deaths caused by drugs is much higher than the state or national average: 14.6 percent versus 9.5 percent in the state and 13.1 percent in the nation.

Despite its own unwieldy name and acronym — the Screening, Brief Intervention and Referral to Treatment, or SBIRT — the program is straightforward in its design. Anyone who comes into the emergency department is asked five questions, three of them relating to alcohol use, one on drug use and one on tobacco use, that have been researched and tested.

If someone scores at a level in this prescreen that indicates a higher than healthy use, a counselor is immediately notified, Golden said. The counselor — Stony Brook has hired six, including Sinnott — then gives the person a longer questionnaire.

Some of those might then receive a brief counseling session, informing them of risks to their health. A smaller number, based on their score, will have an appointment set up right then by the counselor to enter a treatment program.

“Identifying and connecting the patient to a community-based or inpatient program when they are in our facility can make a life-and-death difference in the patient’s recovery,” Golden said.

Much of the Stony Brook program is patterned after a SBIRT program already underway at four emergency departments at three Northwell Health hospitals — Southside Hospital in Bay Shore, Staten Island University Hospital’s two campuses and Lenox Hill Hospital in Manhattan — and four of it primary care practices. Funded from August 2013 until August 2018 by a $10 million federal grant, the program, with nine full-time health coaches, so far has given 142,426 prescreens, said Dr. Sandeep Kapoor, director of SBIRT in the Department of Emergency Medicine, Internal Medicine & Psychiatry/Behavioral Health at Northwell Health. Of those, 5,075 brief counseling sessions were administered and there were 2,089 referrals to treatment.

Kapoor said the key is having trained and approachable health coaches or counselors who make it easy for patients to answer the questions truthfully and who, if needed, can coordinate their care right then.

Too often now, patients — if a substance abuse problem happens to be identified — leave a hospital or doctor’s office with only a list of phone numbers to call for treatment, Kapoor said.

“The onus is on them to follow through,” he said.

This program changes that, he said. “We want to make sure they aren’t left out there to navigate for themselves.”

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