WIPHL Grows Through High Volumes, New Research, and Statewide Support

Numerous studies have shown that simple screening and intervention programs can help people with substance abuse change their behavior before it causes serious harm. Unfortunately, many primary care clinics lack the systems to offer these services.

That's where the Wisconsin Initiative to Promote Healthy Lifestyles (WiPHL) comes in. With Department of Family Medicine Associate Professor Richard L. Brown, MD, MPH, as its clinical director, WIPHL provides screening, brief intervention, and referral to treatment (SBIRT) services at 23 primary care clinics in Wisconsin.

With over 40,000 patients screened so far, a new study on depression screening, and increased policy efforts, WIPHL is working to help even more people in Wisconsin lead healthier lives.

High-Volume, Effective Clinical Services

Since its launch in March 2007, WIPHL has delivered a considerable volume of SBIRT services to people in Wisconsin. As of July 31, 2008, the program provided over 40,000 brief screens, over 6,000 brief interventions, 135 referrals to treatment, and 42 patients with treatment.

Brief screening consists of a few verbal questions-easily integrated into any clinic visit-to identify people at risk for alcohol and drug abuse. People who score positively on those questions are offered brief intervention: a meeting with a health educator, trained and supported by WIPHL, to jointly consider options for changing their substance use.

According to Brown, this approach works. "A study by the National Commission on Prevention Priorities showed that alcohol screening is the fourth most effective preventive service primary care clinicians can provide," he said. "It's more effective than screening for cancer, diabetes, or hypertension."

Testing Feasibility of Depression Screening

WiPHL's next potential clinical focus is screening and treatment for depression. Studies have shown that approximately 10 percent of primary care patients suffer from depression-a prevalence that increases among people with alcohol and drug problems-and nearly half of those patients go undetected. As with substance abuse, many primary care practices simply lack the systems to effectively diagnose and treat patients with depression.

To help address this problem, WIPHL is embarking on a study to determine whether health educators-who do not necessarily have special mental health licensure or certification-can provide effective screening, intervention, and referral services for depression.

Five Wisconsin family medicine clinics are participating in the one-year pilot study, which is funded by the UW Institute for Clinical and Translational Research (UW ICTR). Health educators at those clinics will begin training in mid-November, and will begin administering the services after the training phase is complete.

Brief screening for depression works much like that for alcohol and drug abuse. Two screening questions on depression will be added to current questionnaires that include questions on alcohol and drug use. Patients who score positive will then be asked a nine-question battery to assess the severity of their symptoms.

Brief intervention services will include instruction in self-management techniques, such as sleep hygiene, exercise, or social activity. For patients with major depression or suicidality, health educators will work with patients to determine appropriate referrals to and/or treatment with a primary care or mental health professional.

Brown hopes the results of the study will show that with the appropriate training and guidance, health educators in primary care clinics can deliver effective, financially sustainable depression SBIRT services. "This can be a systematic way to identify depressed patients earlier, provide them with appropriate treatment, and prevent patients with minor depression from moving into major depression."

Promoting WiPHL to State Policy Makers

Brown is also working to influence state policy on Medicaid reimbursement for SBIRT services. "Over the past two years, the federal Center for Medicare and Medicare Services has issued new billing codes for SBIRT services, and given permission for state-administered Medicaid programs to reimburse for them in the primary care setting" he said. "Now it's up to the states to decide."

Currently, Wisconsin reimburses for SBIRT services only when provided to pregnant women. With signed statements of support from seven major organizations, including the Wisconsin Medical Society and the Wisconsin Hospital Association, Brown is educating policymakers about the potential benefits of systematically providing SBIRT services to Medicaid recipients.

"Wisconsin is at the top of the list on many measures related to alcohol consumption, including risky drinking, binge drinking, alcohol-related car crashes, and underage drinking," he said. "We need this."

About WIPHL

WIPHL is funded by a grant from the United States Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. The program is administered by the Wisconsin Department of Health Services, and coordinated by the UW Department of Family Medicine.