Levy Sharon, Harris Sion K, Sherritt Lon, Angulo Michelle, Knight John R
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
J Adolesc Health. 2006 Apr;38(4):336-42. doi: 10.1016/j.jadohealth.2005.11.023.
To determine (1) whether physicians agree with recommendations for home and school drug screening, (2) under what circumstances physicians recommend urine drug tests for adolescents, and (3) how physicians manage adolescent patients with positive results. Few clinical practice guidelines have been published on urine drug testing of adolescents, and it is not known when physicians recommend this procedure or how they manage positive results.
Multi-modal survey of a nationally representative sample of physicians conducted April-July 2004. We computed simple frequencies and used backwards selection logistical regression to determine if there were differences in agreement or practices among physicians from different specialties (pediatrics, family medicine, adolescent medicine) or by demographic factors (physician age, gender, practice type or location).
A total of 359 physicians (43% after eliminating ineligibles) completed the survey. Thirty-eight percent would recommend a drug test if were required to return to school, 41% if a parent was concerned, and 46% based on history (without a parent's concern). Forty-eight percent of physicians would share a positive drug test result with parents. A large majority (83%) disagreed with high school drug testing programs.
There is little consensus among physicians regarding the indications for drug testing in the general medical clinic. However, most disagree with school drug testing programs. There is little consistency among physicians in how to proceed when a urine drug test is positive. Professional organizations should consider publishing clinical practice guidelines in order to assist physicians in using this procedure effectively.
确定（1）医生是否认同家庭和学校药物筛查的建议；（2）医生在何种情况下会建议对青少年进行尿液药物检测；（3）医生如何处理检测结果呈阳性的青少年患者。关于青少年尿液药物检测的临床实践指南鲜有发表，目前尚不清楚医生何时会推荐这一检测程序，以及他们如何处理阳性结果。
2004年4月至7月对全国具有代表性的医生样本进行多模式调查。我们计算了简单频率，并使用向后选择逻辑回归来确定不同专业（儿科、家庭医学、青少年医学）的医生或不同人口统计学因素（医生年龄、性别、执业类型或地点）在认同度或实践方面是否存在差异。
共有359名医生（剔除不合格者后占43%）完成了调查。38%的医生表示，如果学生被要求返校，则会建议进行药物检测；41%的医生表示，如果家长担心，则会建议检测；46%的医生表示，基于病史（家长不担心）会建议检测。48%的医生会将药物检测阳性结果告知家长。绝大多数医生（83%）不同意高中药物检测项目。
在普通医疗诊所中，医生对于药物检测的指征几乎没有共识。然而，大多数医生不同意学校药物检测项目。当尿液药物检测呈阳性时，医生在如何处理方面几乎没有一致性。专业组织应考虑发布临床实践指南，以帮助医生有效使用这一检测程序。
