Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
Am J Drug Alcohol Abuse. 2013 Mar;39(2):121-9. doi: 10.3109/00952990.2012.715703. Epub 2012 Sep 19.
Screening, brief intervention, and referral to treatment for substance use depends on reliable identification. The goal of this study was to determine the rate of detection of unhealthy substance use by physicians on teaching and nonteaching medical services at a community teaching hospital.
This cross-sectional study was conducted from February to June 2009. All new medicine admissions to the Teaching Service or the nonteaching Hospitalist Service were assessed for unhealthy substance use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and Drug Abuse Screening Test (DAST). All patients identified with substance use completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Medical record review was also performed to assess physician documentation.
Of 442 eligible patients, 414 consented to participate. Patients on the Teaching Service were more likely to be male, younger, unmarried, non-white, uninsured or receiving publicly funded insurance, and current smokers (p < .01 for all comparisons). Overall, the detection rate for unhealthy substance use was 64.3% (63 of 98 confirmed cases), with service-specific rates of 73.4% for the Teaching Service, compared with 47.1% for the Hospitalist Service (p = .011). ICD-9 coding accounted for 53.1% of identified cases on the Teaching Service and 14.7% of identified cases on the Hospitalist Service (p < .001). Assignment to the Hospitalist Service, being married, and isolated unhealthy drug use were independently associated with decreased physician detection rates.
Our study suggests that unhealthy substance use is more likely to be detected on a Teaching Service than on a Hospitalist Service.
对物质使用进行筛查、简短干预和转介治疗取决于可靠的识别。本研究的目的是确定在社区教学医院的教学和非教学医疗服务中，医生检测到的不健康物质使用的比率。
这是一项横断面研究，于 2009 年 2 月至 6 月进行。使用酒精使用障碍识别测试-消费（AUDIT-C）和药物滥用筛查测试（DAST）评估所有新入院的医学教学服务或非教学医院服务患者的不健康物质使用情况。所有被发现有物质使用的患者都完成了酒精、吸烟和物质使用筛查测试（ASSIST）。还进行了病历审查以评估医生的记录情况。
在 442 名符合条件的患者中，有 414 名同意参与。在教学服务中的患者更可能是男性、年轻、未婚、非白人、没有保险或接受公共资助的保险，并且是当前吸烟者（所有比较的 p <.01）。总体而言，不健康物质使用的检出率为 64.3%（98 例确诊病例中有 63 例），教学服务的检出率为 73.4%，而医院服务的检出率为 47.1%（p =.011）。ICD-9 编码占教学服务中识别病例的 53.1%，而在医院服务中占 14.7%（p <.001）。被分配到医院服务、已婚以及孤立的不健康药物使用与医生检测率降低独立相关。
我们的研究表明，在教学服务中比在医院服务中更有可能发现不健康的物质使用。
