Full title: Evaluation of a Web-based SBIRT Training Curriculum for Primary Care: Providers: Improving Physicians' Competence in Addiction Through Online Training

Bradley Tanner, MD. Clinical Tools, Inc. Chapel Hill, NC, USA.

Introduction: With funding from NIDA (Contract ##HHSN271200900036C ) we created and evaluated a web-based training program for primary care providers that builds skills in substance abuse Screening, Brief Intervention, and Referral to Treatment (SBIRT) . The primary focus is on alcohol and tobacco - other substances of abuse are also included. The experience meets the requirement of AMA PRA Category 1 Credit ™, AAFP Prescribed Credit and NY OASAS.

Methods: We conducted a summative evaluation with 74 primary care physicians. Our goal was to assess the value of clinical skills training including an opportunity to immediately practice the skills learned, complete an assessment, and receive immediate feedback. Subjects were given the choice of evaluating standardized patient cases presented via computer simulation or chat with a live SP actor.

Results: Learners chose to evaluate computer driven simulated patients rather than standardized patients. Learners showed significant improvements pre-training to post-training for the intervention group in scores on knowledge (p >0.009) and clinical skills assessment using a patient record, in comparison to controls. Following training, nearly all participants intended to increase their use of brief interventions regarding tobacco, alcohol and drug use and to follow up with patients after brief interventions or referral. Audience satisfaction with the program was high as was their rating of the educational value of the program.

Conclusion: A web-based skills training curriculum can confer both knowledge and skills necessary to deploy successful SBIRT interventions in primary care. Future studies can assess success for specific providers (e.g., OB/GYN, geriatric, acute care) or patients (by substance used or intensity of use) and guide further tailoring of the curriculum.

ABSTRACT The authors have developed and assessed 2 innovative, case-based, interactive training programs on substance abuse, one for health professional students on alcohol and one for primary care providers on screening, brief intervention, and referral to treatment (SBIRT). Both programs build skills in substance abuse SBIRT. Real-world effectiveness trials involving medical students (n = 10) and nursing students (n = 60) were completed; trials involving primary care providers (n = 65) are in progress during 2011. Medical students and nursing students had similarly low baseline scores on assessments that benefited from training: knowledge, confidence, and clinical performance measured via an online standardized patient case and encounter note all improved post-training. Preliminary results indicate that practicing providers improved on knowledge, attitude, and brief intervention skill performance after a similar training. Results suggest that SBIRT skills can be improved with this model for case-based interactive training programs, and thus, that this training has the potential to impact patient outcomes.

Objectives

To evaluate effectiveness of an online training program in preparing health care students to address tobacco use with patients.

Methods

The program was evaluated on knowledge, attitude, self-efficacy, intended behavior, and user satisfaction. Participants consisted of 4,180 medical, nursing, dentistry, pharmacy, and other allied health professions students. Multiple choice questions assessed knowledge before and after the educational experience. Likert scales were used for self-reporting of attitude, self-efficacy, and intended behaviors towards tobacco cessation treatments in both a pre-module and post-module survey condition. Likert scores for satisfaction were recorded in a post-module survey. Two sample paired t-tests were used to measure statistical significance.

Results

The knowledge increased significantly for all modules across users. Attitude, self-efficacy, and intended behavior scores increased. The Overview course's knowledge score increased from 59% to 89% (t₍₆₄₉₎ = 61.9; p < 0.0001). Mean knowledge scores for all modules combined increased from 51.5% to 74.0% post-test. Satisfaction with the curriculum was high, with a mean score of 4.6 out of 5.

Conclusions

The success of this program is evident by overall satisfaction, and increases in knowledge, self-efficacy, attitudes, and behaviors, as well as the ease with which it was deployed to thousands of students. Results of this study demonstrate that online training in tobacco cessation is an efficient and effective method of teaching students skills in tobacco cessation counseling, and can fill a vital gap in existing curricula.