Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Pediatrics. 2012 Jun;129(6):1072-82. doi: 10.1542/peds.2011-1624. Epub 2012 May 7.
Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system.
We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and "talking points" designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up.
Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38-0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57-0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17-0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32-0.71).
Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.
初级保健提供者需要有效的策略来对青少年进行药物使用筛查和简短咨询。我们研究了一种新的计算机辅助筛查和提供者简短建议（cSBA）系统的效果。
我们使用了一种准实验、异步研究设计，每个地点都是自己的对照。2005 年至 2008 年，新英格兰 9 家医疗办公室（n=2096 名，女性占 58%）和捷克布拉格的 10 家医疗办公室（n=589 名，女性占 47%）招募了 12 至 18 岁前来常规就诊的青少年。患者仅在初始常规治疗研究阶段完成测量。然后，我们对提供者进行了 1 小时的培训，并启动了 cSBA 阶段。在见提供者之前，所有接受 cSBA 的参与者都完成了计算机化的筛查，然后查看了筛查结果、科学信息和真实生活故事，说明了药物使用的危害。提供者收到了筛查结果和“谈话要点”，旨在提示简短建议 2 到 3 分钟。我们在 3 个月随访时检查了过去 90 天内的酒精和大麻使用、开始和停止率，在 12 个月随访时检查了过去 12 个月内的情况。
与常规治疗相比，cSBA 患者在新英格兰的随访中报告的酒精使用量较少（3 个月时的比例为 15.5%比 22.9%，调整后的相对风险比[aRRR]为 0.54，95%置信区间为 0.38-0.77；12 个月时的比例为 29.3%比 37.5%，aRRR=0.73，0.57-0.92），而在布拉格的大麻使用量也较少（3 个月时的比例为 5.5%比 9.8%，aRRR=0.37，0.17-0.77；12 个月时的比例为 17.0%比 28.7%，aRRR=0.47，0.32-0.71）。
计算机辅助筛查和提供者简短建议似乎有望减少青少年初级保健患者的药物使用。
