Care coordination in screening, brief intervention, and referral to treatment (SBIRT): A scoping review

Abstract

Background and Objectives: Implementation of screening, brief intervention, and referral to treatment (SBIRT) for substance use in primary care remains challenging. Care coordination (CC) may strengthen SBIRT by supporting brief interventions, improving referral follow-through, and enhancing continuity. CC models and outcomes vary, however, and no prior scoping review has synthesized these. Methods: A comprehensive search of 10 resources, including Embase, MEDLINE, and PsycINFO, was conducted on 4/15/2025. Eligible studies described outpatient SBIRT models adding CC for any age group. Articles were excluded if they lacked CC, presented no original data, or were not in English. Relevant implementation and patient-level outcomes were extracted to describe CC models and their impact. Results: Of 737 abstracts and 50 full texts reviewed, 15 met the inclusion criteria. Studies spanned primary care, specialty care, and age ranges. CC models included embedded behavioral health providers, centralized linkage managers, and remote coordinators using phone or digital platforms. CC was associated with higher screening completion, brief intervention delivery, referral initiation, and treatment engagement. Successful integration incorporated structured communication, follow-up protocols, and accessible technology. Barriers included limited billing infrastructure, weak electronic record integration, and unclear roles. Discussion and Conclusions: CC appears to enhance SBIRT implementation and treatment engagement across outpatient settings. Embedded approaches offer relational benefits, while remote and digital strategies show promise for scalability. Comparative studies are needed to assess effectiveness, cost, and contextual fit. Scientific Significance: Provides the first review of CC models within SBIRT, highlighting their implementation impact and guiding future optimization.