Van Hook Shari, Harris Sion Kim, Brooks Traci, Carey Peggy, Kossack Robert, Kulig John, Knight John R
Medicine, Children's Hospital Boston, Boston, Massachusetts, USA.
J Adolesc Health. 2007 May;40(5):456-61. doi: 10.1016/j.jadohealth.2006.12.007. Epub 2007 Feb 15.
To identify barriers to adolescent substance abuse screening in primary care.
Focus groups were held at six primary care sites with a total of 38 providers. Providers brainstormed a list of barriers, collectively grouped similar barriers, and voted to produce a final ranked list. Two investigators qualitatively analyzed field notes and transcripts to triangulate findings, ranked the barriers across all sites by the number of groups identifying the barrier, then calculated a mean ranking (MR) for each.
The most commonly identified barrier was insufficient time (MR 1.8). Lack of training in how to manage a positive screen was ranked second (MR 1.7), but was linked to the first. Providers reported they had enough time to administer a short screen, but insufficient time to manage a positive result during the well care visit. The need to triage competing problems (MR 3.0), lack of treatment resources (MR 3.3), tenacious parents who would not leave the room for a confidential discussion (MR 2.5), and unfamiliarity with screening tools (MR 3.0) were also noted by more than one group.
Insufficient time and lack of training in how to manage positive screens are the greatest barriers to screening adolescents for substance abuse. This suggests that some providers might differentially avoid screening youth who they suspect will screen positive, yet these patients would benefit most from early recognition. More research is needed on effective ways to manage positive substance abuse screens in primary care.
确定初级保健中青少年药物滥用筛查的障碍。
在六个初级保健机构与总共38名提供者进行了焦点小组讨论。提供者们集思广益列出障碍清单，将相似的障碍归为一组，然后投票得出最终的排名清单。两名研究人员对现场记录和文字记录进行定性分析以验证研究结果，按识别该障碍的小组数量对所有机构的障碍进行排名，然后计算每个障碍的平均排名（MR）。
最常被提及的障碍是时间不足（MR 1.8）。在如何处理阳性筛查结果方面缺乏培训排名第二（MR 1.7），但与第一个障碍相关。提供者报告称他们有足够时间进行简短筛查，但在健康检查期间没有足够时间处理阳性结果。不止一个小组还提到需要对相互竞争的问题进行分诊（MR 3.0）、缺乏治疗资源（MR 3.3）、固执的家长不让离开房间进行保密讨论（MR 2.5）以及对筛查工具不熟悉（MR 3.0）。
时间不足以及在如何处理阳性筛查结果方面缺乏培训是青少年药物滥用筛查的最大障碍。这表明一些提供者可能会有差别地避免对他们怀疑会筛查出阳性的青少年进行筛查，然而这些患者将从早期识别中受益最多。需要更多关于在初级保健中有效处理阳性药物滥用筛查结果的方法的研究。
