15 Apr 08 10:45 | RichardSaitz said regarding ScreeningAndBriefIntervention:
JCAHO should support SBI Implementation
JCAHO Should Be Actively Involved in Supporting SBI I believe the JCAHO should be actively involved in supporting SBI because 1) unhealthy substance use is very common in the population, and much more common and severe in healthcare settings, 2) substance-related risks and diagnoses are underrecognized by clinicians, and 3) identification of patients with nondependent alcohol use can decrease use and prevent problems, and treatment is effective for those with substance dependence. JCAHO could support SBI by measuring the occurrence of the practice, reporting on this activity, and making SBI practices standard of care (much as it has with pain). In doing so, JCAHO would need to assess clinical practice guidelines in this area and implement its programs in accordance with those guidelines (which may differ by clinical areas, scenarios). For example, the USPSTF recommends universal screening for unhealthy alcohol use in primary care settings. Thus, such settings should screen all patients for unhealthy alcohol use. Another example, is that in some clinical circumstances, it is clear that patients should be assessed for drug use (example: skin injection marks>>assess patient for injection drug use). In hospitals there has been great concern about medication errors. For any hospitalized patient (or outpatient, or any patient for that matter), needs to have alcohol and drug use assessed (among other reasons) to avoid medication errors and adverse effects (eg interactions between alcohol and acetaminophen; interactions with centrally acting medications, etc etc). Once unhealthy use is identified, as with any other identified health risk, it should be assessed and addressed.

In sum, given that substance use is common, and related health problems are costly and amenable to prevention and intervention, and given that the state of addressing these issues in healthcare settings at the moment is documented to be poor at best (and in reality quite frighteningly poor--most patients not screened with any validated test/questionnaire; 10% of patients in primary care with DOCUMENTED alcohol dependence received any care for it--McGlynn, New Engl J Med) it seems appropriate for the JCAHO to get involved to improve the quality of care.