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Thank you, Dr. Saitz, for your valuable perspectives and opinions regarding this article.
For clarification, the intent of the article is to raise awareness amongst my practicing peers that a tool is available to assist in the identification of those having co-morbid behavioral health conditions when coming in for medically related chief complaints. When I reviewed my organization's statistics on the rate of be...
Competing Interests: None declared. - SBIRT is neither a vital sign nor is it efficaciousShow More
The fact that screening can identify people with a diagnosis that would not otherwise be identified does not mean that any health benefit accrues. And screening has costs and opportunity costs. SBIRT is not a vital sign. Substance use might be. And certainly knowing whether a patient uses drugs or alcohol excessively is important for safer prescribing and diagnosis of medical and other mental health conditions. But iden...
Competing Interests: None declared. - Author response: Improving kept referral appointmentsShow More
Thank you Dr. Susman for your comments regarding the SBIRT paper.
Certainly, the low kept-appointment rate data is eye-opening and concerning. As physicians, we got pretty good at identifying and diagnosing behavioral health issues; even got good at brief interventions but with such low rates of patients keeping their appointments with counselors, I became concerned about our ethical responsibilities and pot...
Competing Interests: None declared. - SBIRT: Promise Waiting to be FulfilledShow More
I appreciate Dr Dwinnells' real world application of SBIRT within a community health center. The increase in identification and referral rates are impressive. Unfortunately, ultimate kept-appointment rates, and presumably, influence on outcomes, remained limited. For me, the challenge of positively affecting behavioral health outcomes in the real world, is designing programs that not only enhance identification and re...
Competing Interests: None declared. - Author response Re:SBIRT is a highly effective toolShow More
Thank you Dr. Sitarik for your comments!
As you know, one of the prevailing comments from providers is that patients will not want to participate in this activity. They claim that it is too invasive and personally sensitive. The basis of my next paper is on an IRB approved survey of our patients who have gone through our SBIRT process. The findings essentially show that patients are more than willing to be...
Competing Interests: None declared. - Behavioral health is healthShow More
Dr. Dwinnells' report is a strong reminder that we family physicians need to integrate behavioral and mental health services more closely. Co-location is an attractive model, with the "referral" being initiated with an in-person introduction to the psychotherapist, counselor, or psychiatrist. Of course, these changes would require major changes in the structure and funding of primary care. And such a model needs further...
Competing Interests: None declared. - SBIRT is a highly effective toolShow More
I find Dr Dwinnells' article concise, well written, and well implemented. The results validate my personal experience. SBIRT is a highly effective tool that facilitates a necessary dialogue between patient and provider. The screening takes little time when implemented routinely during the nursing assessment. The screening tools seems to help break down existing barriers to this dialogue, most notably patients shame and gu...
Competing Interests: None declared.