Cherpitel Cheryl J, Ye Yu
Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA.
Drug Alcohol Depend. 2008 Oct 1;97(3):226-30. doi: 10.1016/j.drugalcdep.2008.03.033. Epub 2008 May 21.
Substance use problems are overrepresented in probability samples of patients in primary care settings including the emergency room (ER) compared to the general population. While large proportions of those with alcohol or drug use disorders are most likely to obtain services for these problems outside the mental health or substance abuse treatment system, accounting, in part, for this overrepresentation, little is known about the association of alcohol misuse or drug use with health services utilization in the general population.
The prevalence and predictive value of alcohol misuse and drug use on ER and primary care use was analyzed on 6919 respondents from the 2005 National Alcohol Survey (NAS).
Among those reporting an ER visit during the last year, 24% were positive for risky drinking (14+ drinks weekly for men and 7+ for females and/or 5+/4+ in a day in the last 12 months), 8% for problem drinking, 3% for alcohol dependence, and 7% for illicit drug use greater than monthly. Figures for primary care users were, respectively: 24%, 5%, 3%, and 3%. ER users were more likely to be positive for problem drinking and greater than monthly illicit drug use compared to non-ER users, while no significant differences were found in substance use for users and non-users of primary care. In logistic regression controlling for gender, age, and health insurance, problem drinkers were twice as likely as non-problem drinkers (Odds ratio, OR=1.99) (p<0.01), and those reporting greater than monthly drug use were almost twice as likely as those using drugs less frequently or not at all (OR=1.92; p=0.01) to report ER use, while those reporting alcohol dependence were 1.63 times more likely to report primary care use (p<0.05).
These data support the belief that both the ER and other primary care settings are important sites for identifying those with substance use problems and for initiating a brief intervention.
与普通人群相比，在包括急诊室（ER）在内的初级保健机构的概率样本中，物质使用问题的比例过高。虽然很大一部分患有酒精或药物使用障碍的人最有可能在心理健康或药物滥用治疗系统之外获得针对这些问题的服务，这在一定程度上解释了这种过高的比例，但对于普通人群中酒精滥用或药物使用与医疗服务利用之间的关联知之甚少。
对2005年全国酒精调查（NAS）的6919名受访者分析了酒精滥用和药物使用对急诊室和初级保健利用的患病率及预测价值。
在报告去年去过急诊室的人群中，24%存在危险饮酒阳性（男性每周饮酒14杯以上，女性每周饮酒7杯以上和/或在过去12个月中一天饮酒5杯以上/4杯以上），8%存在问题饮酒，3%存在酒精依赖，7%存在每月以上的非法药物使用。初级保健使用者的相应比例分别为：24%、5%、3%和3%。与非急诊室使用者相比，急诊室使用者更有可能存在问题饮酒阳性和每月以上的非法药物使用，而初级保健使用者和非使用者在物质使用方面未发现显著差异。在控制性别、年龄和医疗保险的逻辑回归分析中，问题饮酒者报告急诊室就诊的可能性是非问题饮酒者的两倍（优势比，OR = 1.99）（p < 0.01），报告每月以上药物使用的人报告急诊室就诊的可能性几乎是非频繁使用或不使用药物者的两倍（OR = 1.92；p = 0.01），而报告酒精依赖的人报告初级保健就诊的可能性高1.63倍（p < 0.05）。
这些数据支持这样一种观点，即急诊室和其他初级保健机构都是识别存在物质使用问题者并开展简短干预的重要场所。
