Edlund Mark J, Unützer Jürgen, Wells Kenneth B
VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, North Little Rock, Arkansas, USA.
Med Care. 2004 Dec;42(12):1158-66. doi: 10.1097/00005650-200412000-00002.
We sought to estimate national rates of screening and treatment of alcohol, drug, and mental (ADM) problems in primary care.
This was a cross-sectional survey administered from 1997 to 1998.
Our study included a nationally representative household probability sample of 7301 primary care patients.
We used patient self-reports from a telephone survey to estimate rates of screening and treatment of common ADM problems, to examine the types of screening and treatment received, and to investigate adherence with treatment recommendations. Covariates included measures of ADM conditions, physical health, and sociodemographic indicators.
Among adult primary care patients, 38.6% (95% confidence intervals [CI] 37.2-40.0) reported clinician screening for an ADM problem. Alcohol or drug screening occurred more frequently (28.3%; 95% CI 27.0-29.6) than screening for depression and anxiety (21.2%; 95% CI 20.1-22.2). Among those screened, 30.1% (95% CI; 27.8-32.4) reported ADM treatment in primary care. Medications (16.4%; 95% CI 14.3-18.5) and counseling (18.2%; 95% CI 16.1-20.3) were the most common treatments. Rates of screening were higher among individuals with ADM disorders, the young and middle aged, and the college educated. Treatment rates were higher among individuals with ADM disorders.
Substantial effort is expended screening and treating common ADM problems in primary care, and these efforts are targeted towards those with ADM disorders. However, only about half of individuals with an ADM disorder report being screened, and among this group, about 60% report receiving any treatment.
我们试图估算初级保健中酒精、药物和心理（ADM）问题的全国筛查率和治疗率。
这是一项于1997年至1998年进行的横断面调查。
我们的研究纳入了7301名初级保健患者的具有全国代表性的家庭概率样本。
我们通过电话调查中的患者自我报告来估算常见ADM问题的筛查率和治疗率，检查所接受的筛查和治疗类型，并调查对治疗建议的依从性。协变量包括ADM状况、身体健康和社会人口学指标的测量值。
在成年初级保健患者中，38.6%（95%置信区间[CI] 37.2 - 40.0）报告临床医生对ADM问题进行了筛查。酒精或药物筛查比抑郁症和焦虑症筛查更频繁（28.3%；95% CI 27.0 - 29.6），抑郁症和焦虑症筛查率为21.2%（95% CI 20.1 - 22.2）。在接受筛查的患者中，30.1%（95% CI；27.8 - 32.4）报告在初级保健中接受了ADM治疗。药物治疗（16.4%；95% CI 14.3 - 18.5）和咨询（18.2%；95% CI 16.1 - 20.3）是最常见的治疗方式。ADM障碍患者、年轻人和中年人以及受过大学教育的人筛查率较高。ADM障碍患者的治疗率较高。
在初级保健中，为筛查和治疗常见ADM问题付出了大量努力，且这些努力针对的是患有ADM障碍的人群。然而，只有约一半的ADM障碍患者报告接受了筛查，在这一群体中，约60%报告接受了任何治疗。
