SBIRT Case Analysis: Three Patient Scenarios

This paper analyzes three patient scenarios using the SBIRT (Screening, Brief Intervention, and Referral to Treatment) framework. For each scenario, we will explore potential DSM diagnoses with modifiers, severity, urgency of treatment, and ideal level of care. We will also evaluate the overall quality of the SBIRT assessment and identify areas for further information.

Scenario 1: Sara (Hypertension)

1. DSM Diagnosis with Modifiers: N/A (DSM-5 is not used for diagnosing physical health conditions like hypertension)
2. Severity: Stage 1 Hypertension based on JNC 8 guidelines (James et al., 2014). Blood pressure reading of 160/90 mmHg is above the recommended threshold.
3. Single Episode or Recurrent: Based on the information provided, it appears to be a recurrent issue as her last visit showed elevated blood pressure as well.
4. Urgency of Treatment: While not a medical emergency, it’s important to address this to prevent long-term complications. Early intervention is crucial.
5. Level of Care: Outpatient management with a primary care physician is likely appropriate, assuming no underlying medical conditions requiring specialist intervention.
6. Overall Quality of SBIRT: The SBIRT assessment focuses on behavioral aspects of hypertension management, which is not directly applicable here. However, identifying elevated blood pressure highlights the need for further medical evaluation and treatment.

Additional Information Needed:

• Patient’s medical history, including any existing diagnoses or medications.
• Lifestyle factors such as diet, exercise habits, and smoking status.
• Family history of hypertension.

Scenario 2: Monty (Dyslipidemia)

1. DSM Diagnosis with Modifiers: N/A (Similar to Scenario 1, DSM-5 is not used for physical health conditions)
2. Severity: High-risk lipid profile with elevated LDL-C and triglycerides, and low HDL-C based on AHA treatment guidelines (Grundy et al., 1999).
3. Single Episode or Recurrent: No information provided, but given the nature of dyslipidemia, it’s likely to be a chronic condition requiring ongoing management.
4. Urgency of Treatment: Lifestyle modifications and medications can significantly improve the lipid profile and reduce the risk of cardiovascular disease. Early intervention is recommended.
5. Level of Care: Similar to Scenario 1, outpatient management with a primary care physician is likely appropriate, potentially in collaboration with a dietician or nutritionist.
6. Overall Quality of SBIRT: The SBIRT assessment doesn’t directly address dyslipidemia. However, identifying smoking as a risk factor is valuable.

Additional Information Needed:

• Patient’s medical history, including any existing diagnoses or medications.
• Family history of cardiovascular disease.
• Detailed lipid profile results including all cholesterol fractions.

Scenario 3: Beatrice (Asthma)

1. DSM Diagnosis with Modifiers: Asthma, Mild, Recurrent (based on symptoms and history)
2. Severity: Mild persistent asthma based on the description of symptoms (increased use of rescue inhaler, nighttime cough).
3. Single Episode or Recurrent: Recurrent, as her asthma has been diagnosed for 5 years.
4. Urgency of Treatment: While not an emergency, uncontrolled asthma can worsen and lead to complications. Treatment adjustments are needed.
5. Level of Care: Outpatient management with a primary care physician or pulmonologist familiar with asthma management is likely appropriate.
6. Overall Quality of SBIRT: The SBIRT assessment might not have been comprehensive given the focus on behavioral interventions for substance abuse. However, identifying uncontrolled asthma symptoms highlights the need for further evaluation and treatment adjustments.

Additional Information Needed:

• Details about current asthma medication regimen and adherence.
• Assessment of asthma triggers and environmental factors.
• Lung function testing to assess severity and response to treatment.

Conclusion

The SBIRT framework can be a valuable tool for identifying potential health concerns, even if not directly applicable to all conditions. In these scenarios, it served as a screening mechanism prompting further medical evaluation and treatment for hypertension, dyslipidemia, and uncontrolled asthma. However, for a more comprehensive assessment, additional information is needed to determine the best course of treatment for each patient.