Self-Administered Screening Tool Helps to Detect Drug Use in Primary Care.
A brief, self-administered screening questionnaire is useful for detecting unhealthy tobacco, alcohol, and other drug use among patients in a primary care setting, according to a study co-authored by a School of Public Health researcher.
In the study, published online in the American Journal of Medicine, researchers report that a substance use screening tool they developed and piloted had generated results with strong “reliability, sensitivity, and specificity.” Substance use screening is widely encouraged in health care settings, but it often is not done because interviewer-administered screening takes up too much clinician time, the authors said.
The questionnaire, which is filled out on a tablet computer, asks patients how many days in the last year they used tobacco, illegal drugs, and “recreational” prescription medications, and how often they drank at least four (for women) or five (for men) alcoholic drinks in a day.
The tool was developed and tested in New York and Boston hospital clinics by researchers from the New York University School of Medicine and Richard Saitz, professor of community health sciences at SPH and professor of medicine at the School of Medicine. Adults aged 18 to 65 years were enrolled in two studies: a “test-retest” reliability study, in which the screening tool was administered twice within a two-week period, and a validation study, in which it was compared with standard measures, including self-reporting and saliva drug tests.
Researchers reported that the screening tool had “high sensitivity” for detection of unhealthy use of tobacco, alcohol, and other drugs, and that it compared favorably with other widely recommended brief screening tools—all of which are interviewer-administered.
The questionnaire is “the first such screening instrument to be rigorously validated in primary care patients,” the researchers said. “We found that it was feasible to administer, with good sensitivity and specificity. . . . We believe its use can be recommended in primary care settings.”
They said interviewer-assisted screening questions “still require significant staff time and training to administer”—time that could be saved by having patients fill out the questionnaires in waiting rooms, using a kiosk or tablet computer. They also suggested that people might be more forthright in disclosing drug use on a self-administered form, noting that “patients may be reluctant to report stigmatized behavior to an interviewer face-to-face.”
The authors acknowledged that using a screening tool may require further assessment of patients to guide interventions, but they said there were “strong clinical reasons” for including illicit and prescription drug misuse in screening.
“Drug use has profound effects on the management of medical conditions, including drug-medication interactions, medication adherence, risk of overdose from prescription opioid misuse, and overall health-related quality of life,” they said.
Having information about a patient’s drug use can assist clinicians in “carrying out activities that are integral to the quality and safety of the medical care they provide, including safer prescribing, making correct diagnoses, identifying common comorbidities, and engaging patients in management of their other medical conditions.”
Submitted by: Lisa Chedekel